The health sector in Australia has been experiencing significant and complex issues for some time around ageing assets; effective delivery of services to regional, remote, or disadvantaged communities; increasing and ageing populations; efficiently harnessing technology; and rapidly increasing capital and recurrent costs.
Now more than ever, in collaboration with our communities, healthcare workers and all stakeholders, we need to reimagine the way we deliver health services to cater for the new paradigm we face.
This involves thinking holistically across the whole value chain of health service delivery from strategy to the implementation of changes to the physical environment in which health services are delivered. Overall, we need a focus on patient-centred care that is accessible to all, integrated, appropriately financed, flexible, technologically-enabled and sustainable in the long-term.
Underpinning this need for change is the principle that every person has a fundamental right to access quality healthcare. In Australia, as with many nations around the world, we are challenged by the tyrannies of distance and equity and ensuring delivery of high-quality health services to remote and indigenous communities, where health facilities are not as prolific or advanced as in metropolitan areas.
We are also faced with those in lower socio-economic situations, and those already experiencing underlying poor health, who may require extra care at little or no cost.
Colin Hackwood, who acted in the role as Director, Program Advisory and Health Lead, NSW, at Aurecon during the COVID-19 pandemic, shares his thoughts on the future of healthcare delivery in Australia, based on this principle, in the video below.
Out of adversity comes opportunity and certainly in the current era of necessity, innovation will come to the fore. What we have realised in the current crisis is that situations can arise and change rapidly, with little time for preparation.
Flexibility and adaptability therefore become essential.
Now, the need for more hospital beds in high acute, that is Intensive Care Units (ICUs), High Dependency Units (HDUs), and step-down areas, and subacute areas for infectious diseases, is critically important. Will this be the way of the future? Will infectious diseases become more common and spread faster than we have ever seen before, or will we develop the means of stopping them in their tracks before an outbreak becomes a pandemic?
We can’t be sure but being able to quickly turn inpatient wards into ICUs for example, as well as repurposing other areas (while sending lessor acuity patients elsewhere or home) and back again will become the new norm. Designing in this flexibility in the spaces as well as the technology to deliver the requisite services when needed from the outset will be crucial.
As we have seen in this crisis, and many before, a seamless, local supply chain can be the game changer between waiting weeks or months for emergency equipment and resources and being able to ramp up rapidly to fill a rising demand. While it will be shown to be commercially non-viable to re-establish some elements of the supply chain previously lost, or to establish all elements that don’t exist, developing a local supply chain for selected essential equipment, and procurement procedures that allow for fast and efficient delivery, will become vital.
Healthcare delivery is typically labour intensive, particularly for intensive care facilities, where the staff-patient ratio is 1:1. In a medical crisis, when the number of patients dramatically increases, this ratio is stretched, if not impossible to achieve, which begs the question: is there another way to deliver the medical staff-patient ratio without the use of human beings in every situation?
We have seen how telehealth is rapidly enabling more remote delivery of some primary medical services, but what technology, perhaps robotic solutions that go beyond simple physiological monitoring, could deliver intensive care services, at least for a portion of time or for lower-level care, leaving high level care to the humans who need to make crucial decisions?
The overarching intent of our leaders has been consistent; that is, how do we ensure we save lives and balance that with the economic consequences that are arising out of the measures being implemented.
However, the current crisis has seen an inconsistency of some messaging and responses between some authorities and jurisdictions. Differing rates of new cases, coupled with varied approaches and capacities to cater for the rising pandemic, has left health services responding to the current situation and emerging issues as best they can with the information available at the time. This has led to some confusion and non-compliance of a population receiving mixed messages.
As infectious diseases spread via the movement of people and as we become ever more mobile, this situation will only intensify. A consistent approach to sharing and managing information and communication will be vital, and technology will be the enabler. Improved information and communications governance enabling leadership and decision-making are the fundamental outcomes. Designing healthcare delivery systems with a high level of digital capability will be essential.
While telehealth technology delivering health information and services over both long and short distances, digital management of hospital patient flows to improve efficiencies and release bed capacity, and remote monitoring of patients already exist, there is no doubt that this will need to increase in the future.
Pivoting towards remote health service delivery will mean a change in the design and purpose of hospitals and other medical facilities and the way in which health professionals work, ensuring the appropriate technology is accessible to those delivering and receiving the services.
Patients will no doubt become more empowered, more informed and wish to be in control in an equitable partnership with their healthcare provider. We do note that the experience, convenience as well as human interaction will remain key for some time into the future.
In terms of wellness, Australians rank better than the OECD average in most areas except obesity and alcohol consumption, so plenty of good, together with some opportunity!
However, total health expenditure in Australia has grown five per cent per annum for the past 10 years which significantly exceeds GDP growth per annum, making the current paradigm unsustainable. This hypothesis is only reinforced when you realise our health expenditure is the 7th highest in the world per capita based on the latest data, however our GDP per capita ranks some 15th in the world. So, it is obvious that we need to deliver equitable health outcomes for less expenditure.
Representing some 40 per cent of our total expenditure, reimagining hospital design and how health facilities work will be at the core to achieving the changes. The conversation needs to shift from “the P90 cost (project cost with sufficient contingency to provide 90 per cent likelihood that this cost would not be exceeded) is $X” to “how might we reduce the cost by Y per cent and deliver the same health outcomes for patients, health workers, families and the community.”
Crises create a ‘burning platform’ for change and innovation, and COVID-19 is providing the perfect storm to reimagine healthcare design and delivery. While we are focused on the immediate issues in our communities, once we emerge from the crisis, there will be an opportunity to reflect, recalibrate and re-design our healthcare delivery for the future.
This thinking paper is part of a collection of insights and expertise from Aurecon as it explores leading through and beyond the COVID-19 disruption. Explore our insights here.
Ben Coxon is passionate about helping clients achieve their goals by understanding their challenges and working with them to find innovative solutions. With some 30 years’ experience across markets in Asia and Australia, in the delivery of major projects, as well as strategic management roles, he is now focused on working with clients in the healthcare sector in Australia as Aurecon’s Industry Leader, Health.
Colin Hackwood is an internationally-experienced health service and hospital executive who has shaped his 20-year professional career in roles spanning all aspects of health service delivery. He started his career in nursing, gaining invaluable experience in acute care service settings in hospitals in Australia and the UK, before moving to the not-for-profit sector and health service delivery organisations, in developing countries in Africa, Central America, South America and Asia as well as in Australia and the Middle East. Colin has extensive experience as a project director specialising in service reviews, project planning and project scope definition, procurement strategy, project delivery and execution, particularly in complex and changing environments. Colin previously held the role of Director, Program Advisory and Health Sector Leader, NSW for Aurecon.
Ben is supported by a team of professionals across Australia focused on providing healthcare strategy, feasibility, project management, design and asset management services to clients.
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