Workplace Reform in the Healthcare Industry: The Australian Experience

332 Pages·2005·1.038 MB·English

by  Pauline Stanton, Eileen Willis, Suzanne Young (eds.)

Workplace Reform in the Healthcare Industry
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Workplace Reform in the
Healthcare Industry
The Australian Experience
Edited by
Pauline Stanton
Graduate School of Management
La Trobe University
Victoria
Eileen Willis
School of Medicine
Flinders University
South Australia
and
Suzanne Young
Graduate School of Management
La Trobe University
Victoria
© Selection and editorial matter © Pauline Stanton, Eileen Willis
and Suzanne Young Individual chapter © Contributors 2005
Softcover reprint of the hardcover 1st edition 2005 978-1-4039-3571-7
All rights reserved. No reproduction, copy or transmission of this
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First published 2005 by
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Library of Congress Cataloging-in-Publication Data
Workplace reform in the healthcare industry : the Australian
experience / edited by Pauline Stanton, Eileen Willis, &
Suzanne Young.
p. cm.
Includes bibliographical references and index.
1. Health care reform–Australia. 2. Medical policy–Australia.
3. Public health administration–Australia. 4. Health services
administration–Australia. 5. Health facilities–Australia–Personnel
management. 6. Industrial relations–Australia. 7. Medical
personnel–Australia. I. Stanton, Pauline, 1953– II. Willis, Eileen,
1946– III. Young, Suzanne, 1957–
RA395.A8W67 2005
362.1′0994–dc22 2005047310
10 9 8 7 6 5 4 3 2 1
14 13 12 11 10 09 08 07 06 05
Contents
Foreword by Kerryn Phelps vii
Acknowledgements xi
List of Tables xii
List of Figures xiv
List of Abbreviations xv
Notes on Contributors xviii
Introduction 1
Pauline Stanton, Eileen Willis and Suzanne Young
Part I The Australian Healthcare Sector
1 Health Sector and Industrial Reform in Australia 13
Eileen Willis, Suzanne Young and Pauline Stanton
2 The Australian Healthcare Workforce 30
Stephen Duckett
Part II Case Studies in Healthcare Reform and Workplace
Change
3 The Structure of Bargaining in Public Hospitals in Three 63
Australian States
Mark Bray, Pauline Stanton, Nadine White and Eileen Willis
4 Outsourcing and Structural Change 91
Suzanne Young
5 Casual and Temporary Employment in NSW Regional 112
Hospitals
Alex de Ruyter
6 The Processes of Workplace Change for Nurses in 131
NSW Public Hospitals
Nadine White and Mark Bray
v
vi Contents
7 Work Intensification for Personal Care Attendants 150
and Medical Scientists
Eileen Willis and Kerryn Weekes
8 Emotional Labour and Aged Care Work 170
Sue Stack
9 Flexibility at a Cost: Responding to a Skilled Labour 187
Shortage
Keith Townsend and Cameron Allan
Part III Future Challenges in Healthcare Reform and
Workplace Change
10 Inspiring Innovation 209
Sandra G. Leggat and Judith Dwyer
11 Developing a Strategic Approach to People 232
Management in Healthcare
Tim Bartram, Pauline Stanton and Raymond Harbridge
12 Clinical Governance: Complexities and Promises 253
Rick Iedema, Jeffrey Braithwaite, Christine Jorm, Peter Nugus
and Anna Whelan
13 E-Health Services: Is the Future of Australia’s Health 279
Service in Offshore Outsourcing?
Jan Sinclair-Jones
14 Conclusion: Reflections on Past Healthcare Reform 298
and Future Directions
Suzanne Young, Eileen Willis and Pauline Stanton
Index 307
Foreword
The healthcare system is multidimensional and complex. With shifting
demographics, a constantly evolving workforce, increases in technol-
ogy and rising expectations of consumers, healthcare reformists need
to be cognisant that the consequences of change in one area may well
reverberate throughout the entire system.
Depending on the political climate of the day, the perceived need for
healthcare reform ebbs and flows. For many in the community, spec-
ifically people who find themselves in need of timely and excellent
health care, and those of us who work within the system day to day,
the desirability of health care reform is chronic and apparent.
In my role as President of the Australian Medical Association, I quickly
realized that a prerequisite to any constructive involvement in reform of
the Australian health care system is a detailed understanding of the terri-
tory, including the major players, the various levels of political responsi-
bility, the interaction between the various medical groups and the
politics between different types of health care providers. Not to mention
the influence of the media and the expectations of consumers.
Given the intractable inertia that traditionally besieges the process of
change in the health system, I admit I had to throw a few political
grenades to provoke much needed action in areas like workforce plan-
ning, medical indemnity, and public hospital funding.
Sometimes, reform is part of an ideological master plan, but all too
often it comes as a response to a media or lobbying ‘blitzkrieg’. This in
turn can result in piecemeal measures, populist announcements or,
worse still, massive but poorly managed reform which leaves workers
at the coalface struggling with the consequences of change.
Reform comes up against seemingly impenetrable obstacles, the most
glaring example being the nature of health system administration
between Federal, State and Territory governments. When I coined the
phrase ‘blame-shifting’, it was in response to the frustration I was
feeling about the endemic ‘cost-shifting’ between the different levels of
government, who would then sit back and point the finger at each
other as the perpetrator of the problems being faced by people within
the system.
The division of responsibilities in the system also leads to groups of
people, most notably the aged and indigenous communities who fall
vii
viii Foreword
between the cracks. For example, a (Federal) under-resourcing of aged
care places would leave a frail elderly patient in a far more expensive
and less appropriate State-funded acute hospital bed.
Every five years the State and Federal health ministers would get
together to argue about the size of the Federal funding pie, and who
gets what share of it. This meeting is always preceded by posturing,
media conferences, pronouncements of political positioning, the
meeting goes ahead and, given that the States have no choice but to
accept what is on offer, they all go back to their respective capital cities
to reformulate their budgets.
The Federal-State system of health care administration and
funding also means there is a much greater focus on tertiary care to
the neglect of other healthcare sectors. This is largely because of the
immediacy of need for acute hospital beds, and the very public
exposure of deficiencies. Hence the stories of ambulances doing
rounds of the city to find an emergency department open, sick
neonates being airlifted all over the countryside, long waiting times
for elective surgery and so on.
The longer term focus on health promotion and prevention strate-
gies, or chronic community-based care just isn’t top-of-mind and is in
need of far greater attention. An issue emerging in the area of social
justice is the problem of providing adequate medical care in rural and
remote regions of Australia. Economic rationalists argument simply do
not apply when it comes to providing quality healthcare to rural and
remote populations, and a ‘one size fit all’ model cannot apply to all
Australian communities. Local regional planning needs to be a precur-
sor to healthcare delivery, taking into account the special needs of
those populations.
This book looks at the impact of so-called ‘New Public Management’
on healthcare workers, and its sometimes unpredictable and perhaps
unintended impact on medical scientists, nurses, or doctors in the
early stages of their careers. The ultimate impact of a demoralized and
undervalued healthcare workforce will be on patient care as good
people are lost to the system because their concerns have not been
addressed, or because ‘efficiency’ measures failed to take into account
the impact they might have on professionals’ work environment. In a
health system with private and publicly operated workplaces function-
ing side by side, workers have choices. Industrial issues such as the
piecemeal approach to enterprise bargaining across the country, some-
times complicated by the draconian presence of the ACCC, create
inconsistencies and unrest.
Foreword ix
In 2000 when I assumed the role of AMA President, I was con-
fronted with a series of government workforce measures which began
with the assumption that there was an ‘oversupply’ of GPs. This was
repeated like a mantra throughout Health department documents
and Health Ministers’ statements. However, the word from the
trenches told us that, far from being an oversupply, GPs were becom-
ing scarcer by the day and those who remained were just keeping
their heads above water. The workforce planning data had not taken
into consideration the shifting gender balance in general practice,
the move by many GPs to reduce their consulting hours in favour of
other pursuits, how long they intended to keep working in general
practice and so forth. An independent study commissioned by the
AMA analyzed these trends and more, and the ‘oversupply’ became a
drastic undersupply.
Looking to the future, planning of the Australian healthcare work-
force will become increasingly complex following labour market flexi-
bility initiatives such as part-time work and demands for a better
work-life balance.
No view of the future would be complete without a discussion of
e-medicine, which is on an exponential trajectory. There are very real
concerns around possible negative impacts such as invasion of an indi-
vidual’s privacy. It has long been my view that advances in e-medicine,
despite technical readiness, must be preceded by a careful considera-
tion and public debate about the ethical and privacy implications of
new information technology, and appropriate safeguards put in place.
And where do consumers fit into all of this? Certainly the various
‘disease related support groups’ do a magnificent job in rallying volun-
teers and raising awareness. A strong, single unified voice for con-
sumers is lacking though and much of the advocacy for patient care
falls to the healthcare professions who are exposed to the difficulties
encountered by patients, and immersed in the deficiencies of the
administration of healthcare on a daily basis.
Just as evidence-based medicine has become the trend in clinical
practice, so should evidence-based principles be the gold standard in
healthcare reform.
This book draws together some of Australia’s foremost experts in
the areas of healthcare reform and related industrial relations to
examine the principles of healthcare reform and its implications
for the people working within the public system. The authors
also examine some of the lessons of the past, both in Australia and
internationally.