Lois O'Callaghan is the Chief Executive Officer of Mallee Track Health and Community Service (MTHCS). MTHCS is a multipurpose service (MPS) located in the North West of Victoria. MTHCS provides a suite of services from early years, family services, neighbourhood houses, through to community and residential aged care, and limited acute medical and urgent care services to the communities in its 18,000 square km catchment area. Lois is a qualified social worker (1996), with a Masters in Human Service Management (2008). She is a graduate of the Australian Institute of Company Directors (2016). Lois has experience at a practice and management level in early years, aged care, workforce planning, mental health promotion, out of home care, family services, community development and public sector submission writing. She has worked in the public sector (Victoria and South Australia), local government and the not-for-profit sector. Lois has worked in the MPS model for the last 4½ years, overseeing the management of community-based services. During that time, she has developed a professional interest in the MPS model with a focus on progressive universalism.
Multipurpose services (MPS) were initially instigated in the aged care sector to address market failure in rural and remote communities where private market forces would not enter as the cost of service provision outweighs the potential for financial gain. The MPS model has been in existence in Victoria since 1996 (20 years) and has effectively met with aged care needs of the communities within which they operate. The MPS model has received bi-partisan support since inception.
Mallee Track Health and Community Service (MTHCS) is an MPS located in rural north west Victoria which has, over time, added and extended its suite of funded services (outside of the aged care funding) to include a raft of Early Years services such as long day care, kindergartens, family services and disability services.
The Australian Early Developmental Census (AEDC) is a critical data set for children living in rural areas. The AEDC data set which can be applied to the MTHCS catchment indicates that children within the catchment are vulnerable on 2 or more domains. The importance of acting early is already well evidenced and researched in the early childhood domain.
This paper will present:
The information presented will trigger discussion by health and education service providers and policy makers on the potential to expand the MPS concept across the lifespan.
Lydia O’Meara is a Medical Sciences student with CQUniversity and a Project Support Officer with over 10 years of experience working with Queensland Health. For the past four years Lydia has been working in FNQ, immersed in the challenges of coordinating delivery of emergency medicine education to rural hospitals. Lydia grew up on a sheep station in Outback Queensland and is now completing the final phase of her degree in Cairns. Lydia is passionate about advocating for Indigenous health, especially the role of public health policy in raising health equality in rural Australia. In 2015, Lydia travelled to Paris as a delegate to the OECD Public Forum with Global Voices. As part of this scholarship, Lydia undertook a research paper investigating the role of nutrition as a key tool in closing the gap in Indigenous health inequality. More recently as a CQUniversity Summer Research Scholarship recipient, Lydia has been investigating links between the health literacy of Australian adults, socio-demographic characteristics and risk of developing diabetes. The paper Lydia will present at the NRHA conference arises from her role with QHealth, which focuses on the challenges and successes of delivering education to clinical staff working at service-driven facilities in FNQ.
Aims: Upskilling is crucial to the delivery of patient-centred emergency medicine in rural/remote facilities. The Emergency Medicine Education and Training (EMET) Cairns Hub aims to provide high-quality emergency medicine education in service-driven rural facilities of Far North Queensland (FNQ). A secondary outcome is to cultivate the relationship between each referring facility and the receiving regional centre.
Methods: The federally funded EMET Cairns Hub program, commenced in mid-2012 and is overseen by the Australasian College of Emergency Medicine (ACEM). Emergency Physicians (FACEMs) from the Cairns’ Hospital are rostered 3 days each week to deliver training specifically targeted to the needs of rural practitioners working in the eleven rural/remote hospitals that drain to Cairns Hospital. A Program Support Officer and FACEM Clinical Lead administer the program. The educational sessions are delivered by the rest of the Cairns’ ED FACEM team and include outreach workshops, videoconference case-based discussions or expert tutorials, and hi-fidelity simulation workshops. Continuous evaluation coupled with yearly service reviews keeps the program focused on the individual learning needs of each facility.
Relevance: Finding ongoing opportunities to update critical emergency medicine skills can be difficult for staff in rural/remote facilities. Challenges include geographical isolation, staff recruitment and retention, lack of protected education time, high clinical load, and inadequate opportunity to network with FACEMs and other rural/remote staff.
Results: The EMET Cairns’ Hub has delivered four full years of education to rural/remote facilities. Overall, participants hold the program in high regard with many reporting that ongoing contact with FACEMs builds rapport and reduces the geographical isolation they feel, leading to improved patient outcomes. Onsite workshops remain the most highly valued modality as a source of two-way education as FACEMs can assess local challenges. Short, monthly videoconference based education remains the best fit for busy workloads of facilities. One-day, hi-fidelity simulation is highly valued as an intensive critical skills building and networking opportunity. The majority of sites advocate for inclusion of nursing and other allied health staff into all initiatives for the purpose of supporting a multi-disciplinary collegiate culture.
Conclusions: A multi-disciplinary, flexible, multi-modal framework is crucial for the successful implementation and sustainability of education initiatives for busy rural/remote facilities. A grassroots approach tailored to facility needs through regular evaluation and adjustments is critical for creating solutions to overcome ever-changing institutional and service challenges. Underpinning all is a growing network of contacts in a strong collegiate culture to overcome professional isolation.
Prof Peter O’Meara is an internationally recognised expert on paramedicine models of care and education. He was one of the first paramedics in the world to complete doctoral qualification researching paramedicine and is a Fellow of Paramedics Australasia. He is Professor of Rural and Regional Paramedicine in the LaTrobe Rural Health School, Bendigo, with overall responsibility for the development of an innovative four-year paramedicine degree program. Peter’s research has focused on the delivery of paramedic services in rural settings and the development of paramedic extended scope-of-practice roles, in particular the development and implementation of community paramedicine throughout the world. In the field of paramedic education, he has focused on field and clinical placements. His over-riding passion is the emergence of paramedicine as a health profession in Australia and other parts of the world.
For the past 50 years paramedic services and paramedic roles have successfully evolved in response to changes in community needs and expectations. This has seen a transformation from often voluntary, semi-skilled roles to paramedics who have professional education, broad scopes of practice and acceptance as health professionals. Paramedics and the organisations they work are now expected to respond to health system changes and the changing values and expectations of communities through the continuing development of new and innovative models of care.
During the 1950s and 1960s, the volunteer/transport model based on the values of community self-reliance and control, developed in communities to meet local needs for transport to local hospital and medical services. This model has been enhanced and still exists in many parts of rural and remote Australia. The technological model, characterised by professionally staffed and managed ambulance systems providing pre-hospital care based on the medical model including advanced technology and technically-skilled staff, is currently the dominant model in urban and regional settings health systems.
We are now observing the emergence of paramedic practitioner models that are part of integrated pre-hospital systems that provide a range of services to prevent injury and illness, respond to emergencies and facilitate recovery, and aim to produce a healthy community in collaboration with other health professionals. These practitioners, often referred to as extended care paramedics or community paramedics, are working in some Australian States and are more established in parts of Canada and the United States.
This new role places paramedics within an integrated healthcare system, with them sharing roles with other health professionals that best utilize their skills and knowledge. Movement toward a wider implementation of the paramedic practitioner model raises many policy and practice issues issues, including changes in scopes of practice, the design of education programs, and the self-regulation of a new health profession.
Dr Belinda O’Sullivan was awarded her PhD in 2016 for a thesis about patterns of rural outreach by specialist doctors in Australia. She currently works part-time as a Research Fellow at the Monash School of Rural Health, Bendigo where her research focus is on rural health workforce and models of care. She is an active member of the MABEL research team (a large longitudinal panel survey of Australian doctors) and manages the Monash University medical workforce tracking study. Belinda is a graduate of the NSW Public Health Officer Training Program at NSW Health Department. She came to research with fifteen years' experience as a health workforce consultant in training and development.
Background: Access to regional specialists is important to (1) support locally integrated care, providing referral and support for the primary care workforce, (2) prevent over-reliance on aero-medical retrieval and patient travel. However, there are no national studies exploring the types of specialists working rurally, the nature of their work and professional satisfaction according to whether they work in large or small regional centres.
Aims: Systematically describe the characteristics of rural specialists, their work activity and job satisfaction by work location (town size), compared with metropolitan specialists
Methods: A cross-sectional study of 3479 medical specialists participating in the 2014 Medicine in Australia: Balancing Employment and Life (MABEL) survey of doctors. Associations were tested between personal and professional characteristics, the nature of their work and job satisfaction rating and location of their main practice, grouped as metropolitan, large (>50,000 population) or small regional centres (<50,000 population).
Result: Specialists working in large regional centres had similar demographic characteristics and practice sector to metropolitan specialists, however, those in small regional centres were more likely male, later career, overseas-trained and less likely to work privately. Specialists in general medicine and general surgery, although a small group, were significantly more likely to work in large and particularly small regional centres, compared with anaesthetists. A range of other rural-relevant specialties had poorer rural distribution including paediatricians and endocrinologists who were significantly less likely to work in large regional centres than metropolitan areas. Rural specialists working in large and small regional centres had more on-call requirements and poorer professional development opportunities. However, their satisfaction with work hours, remuneration, variety of work, level of responsibility, opportunities to use abilities and overall satisfaction was no different to metropolitan-based specialists.
Conclusion: Rural and metropolitan specialists are both highly satisfied, though those working in large or small regional centres may need more support to manage higher on-call demands and access continuing professional development than their metropolitan colleagues. Fostering the number of specialists in general medicine and general surgery training programs is likely to be important for the supply of rural specialists, particularly in smaller regional centres. Further, government policies to enable employment of overseas-trained specialists are important for small regional centres. In large regional centres, fostering supply of rural-relevant specialists like paediatricians may be enhanced by more rural vocational training pathways and active recruitment networks spanning the public and private sectors.
Leigh-ann Onnis is a lecturer and researcher at James Cook University with an interest in remote workforces, management and health. Starting her career in Human Resources in Melbourne in the early 1990s, Leigh-ann’s interest in ‘people’ and ‘work’ has developed over many years. Leigh-ann has lived in regional and remote northern Australia for twelve years and prior to her current role at JCU, has worked in HR and research roles with Menzies School of Health Research, WA Country Health Services and Queensland Health’s Remote Mental Health Team. It was a management role in the Kimberley that first ignited Leigh-ann’s interest in combining her passion for people management and her interest in public health. Leigh-ann has recently completed a PhD, entitled ‘A Sustainable Remote Health Workforce: Translating HRM Policies into Practice’, which is a culmination of her passion for management, health and remote northern Australia.
The challenges of recruitment and retention of health professionals in rural and remote Australia are well documented. Increases in need arising from an ageing population and the burden of chronic disease, together with a decrease in workforce supply globally, creates further challenges in rural and remote areas where high turnover is frequently reported. This research focuses on rural and remote managers, and seeks to understand where improvements in management practices can have the greatest impact in improving health workforce retention.
Social Exchange Theory proposes that where there are effective employee-manager workplace relationships and where there is perceived organisation support from the employee’s perspective, organisations will observe improvements in retention, as well as improvements across a range of performance indicators. Hence, there are many benefits that arise from an effective employee-manager employment relationship. This research examined the words that health professionals and managers use to describe what it is like to work in rural/remote northern Australia. The aim of the study was to identify if similarities and differences in manager and health professional’s perceptions provide opportunities to improve retention through effective employee-manager relationships.
This qualitative research study used a purposive sampling method to recruit participants who were either managers or health professionals working in rural/remote regions of northern Australia. Twenty-four semi-structured interviews were conducted in-person or via telephone depending on the participant’s location. Participants were asked to provide five words that best described working in a rural/remote community from their perspective and then from the alternative perspective. That is, health professionals in rural/remote areas described their work experience and then how they perceived that their manager would describe it. Managers described it from their perspective and then how they perceived that a remote health professional would describe it.
The research found opportunities to improve retention through the similarities and differences in each group’s perceptions about working in rural and remote northern Australia. Few managers hesitated in describing the health professionals’ perspective, yet many health professions paused and contemplated whether their manager really understood what it is like to work in rural and remote regions. This research provides evidence not that there are differences and similarities; it provides language around where these similarities and differences emerge enabling opportunities to further explore where these misaligned perceptions may be translating into unrealised potential and poor retention of otherwise competent and passionate health professionals.
Fiona Onslow is the Director of Statewide Operations at The District Nurses in Tasmania. Fiona is a registered nurse with a Postgraduate in Family and Community Health. Fiona has overseen a significant program over the last four years to deliver better access to palliative care, with implementation of a model of service delivery entitled hospice@HOME. This model has achieved significant outcomes in assisting people to have their end of life at home and now over 62% of people who wish to die at home, do so. The hospice@HOME packages have 45% of clients living in the outer regional or remote areas as compared to 35.3% of the Tasmanian population, indicating the success of hospice@HOME reaching rural communities.
We only knew Jock for a short time. Jock was known as a character, salt of the earth, a solid guy who towered over everyone but has the softest heart you could imagine. Jocks source of pride was his family and his relationship with his wife was to be envied by everyone. Jock was everyone’s friend, mate, cobber and you would not find a person who had a bad word to say about him. It was with shock and sadness when Jock got sick, he had “had a good innings”, as Jock would say, but he always seemed so strong and someone who would just always be there. Jocks wife Nell was not having anyone take care of Jock as she wanted to be the one caring for him as he had done for her his whole life. Jocks children gathered around and friends were always there. We met Jock when his last days were looming, his family and wife were tired and we asked how we could support them. They knew the hospital which was an hour’s drive away could admit Jock but they told us they wanted him to be home in the highlands were he had been farming his whole life. So we told them what we could do. We asked about a bed which they initially refused, until Nell knew we could get a Double Bed. So we arranged more care, set up the Double Bed and supported Nell as Jock started to slip away. It was Christmas Eve when the daughter phoned to say Jock had died in the early hours, with his wife beside him. Jock died at 2am, and Nell chose to stay with him in bed and hold him, say her final goodbyes, until 6am when she then told the family all gathered in the house that he had died. The daughter thanked us for her mother being able to have that experience because it meant so much to her. The Double Bed.
This is a story that occurred due to an equipment scheme that was as part of a palliative care program established to support people to die in their community and at home, which for rural people has been widely unachievable.
Dr Renée Otmar has broad and extensive expertise in health communications research, policy research and publication, and in program development and management. Her research interests include the use of artificial intelligence to improve health outcomes and the communication of risk across the spectrum of health care and disease. Renée’s early training and qualifications led to roles in public relations, book editing and publishing and, since 2002, to senior roles in the public health and academic sectors. Her strengths are in developing and leading teams, and in analysing, synthesising and tailoring complex scientific and technical data into communications suitable for their intended audiences, across formal and informal settings, contexts and formats. In her role as Business and Communications Manager at Western Alliance, Renée provides support and advice to the Executive Director and the Board of Directors, including policy, planning and implementation, and is responsible for Western Alliance’s day-to-day operations, financial management, communications and staffing. She convenes the Annual Symposium to showcase regional research in western Victoria, and administers the Centre’s research funding portfolio.
Introduction: Academic health science centres (AHSCs) are well established internationally but are relatively new in Australia. AHSCs are underpinned by the three independent pillars of research, education and health care; integrating these pillars presents both a challenge and an opportunity to advance the public health agenda.
Method: Narrative review – Western Alliance academic health science centre and network is presented as a case study for engagement of academic research, public health, primary care, community care and specialised health services in research. While there are multiple potential benefits to be gained from integrating clinical practice and academic inquiry, the ultimate goal is to improve the health and wellbeing of rural and regional communities.
Discussion: Established in early 2014, Western Alliance is a partnership between two universities and 12 major rural and regional health service providers in western Victoria, including public and private hospitals and the primary health network. It works by engaging partner organisations and communities in its mission to improve the impact, quantity and quality of research across a broad geographic area, through collaborative health care, research, education and training.
The focus is on improving health outcomes for rural and regional/remote populations. Collaborative/ integrative projects include research and interventions involving health services, communities and schools; academic researchers; clinician-researchers, health professionals; and trainees/registrars, interns and RHD students. Research topics include childhood obesity prevention; treatment and prevention of harms associated with alcohol and other drugs in young people; associations between ageing and chronic disease and injury; doctor–patient conversations regarding treatment goals; impacts of farm-related trauma; anti-microbial stewardship in general practice; strategies to improve cancer health literacy in small towns; and the use of big data to support clinical decision marking
Implications: It can take many years for evidence from research to be integrated into clinical practice. AHSCs provide an effective vehicle for translation and facilitation of evidence-based practice into health care while building research capacity in health services. The potential for public health benefits to accrue from integrative partnerships of diverse entities, each with its own platform and agenda, outweigh the challenges inherent in doing so.
Key message: The academic health science centre model is new in Australia: it exemplifies contemporary models for evidence-based practice through integration, collaboration and innovation in health care, research and education.