Unlocking skills in hospitals: better jobs, more care

Abstract

Enabling less highly-trained hospital workers to play a bigger role could improve jobs for doctors and nurses, save public hospitals nearly $430 million a year and fund treatment for more than 85,000 extra people, argues this report. Overview Hospitals are under pressure. They face rising demand, a squeeze on funding and skills shortages in key areas. They have to change. One problem is that too many health professionals squander their valuable skills on work that other people could do. In most cases, it doesn’t take 15 years of post-school training to provide light sedation for a stable patient having a simple procedure. Nor does it take a three-year degree to help someone bathe or eat. But tradition, professional culture and industrial agreements often dictate that highly-trained health professionals spend their time doing straightforward work. This wastes money, makes professional jobs less rewarding and often does not improve care. There are many ways that hospitals can get a better match between workers and their work. This report looks at three examples. The first is using more nursing assistants to provide basic care to patients. The second is letting specialist nurses do common, low-risk procedures currently done by doctors. The third is employing more assistants to support physiotherapists and occupational therapists. These changes can maintain or improve the safety and quality of care. They are among the easiest to take up. Hospitals don’t have to be reorganised or new professions created. They would save public hospitals$430 million a year. That could fund treatment for more than 85,000 extra people. These ideas are supported by solid evidence. They have been tried successfully in Australia, with good results for patients. Hospital CEOs we surveyed for this report strongly support them. Despite all this, progress is painfully slow. Formidable barriers in the form of regulations, culture, tradition and vested interests stand in the way. We need a new mechanism to overcome these barriers – a way to get from isolated trials to broad change. Creating that mechanism is even more important than the examples in this report. People may disagree with specific examples. But no-one can argue that all hospital work is done by the right person, or that a good way currently exists to get change throughout the system. Two things are needed. Hospitals, regulators and professional bodies must improve rules and regulations. State governments must invest money and expertise in spreading good practices. If we don’t update workforce roles, there will be a cost. Hospitals already struggle to provide enough care. Waiting lists are long and demand is growing fast. It’s hard to keep some hospital workers in their jobs. Government budgets are also under pressure. If action isn’t taken to make hospitals more efficient, tougher decisions about who will miss out on care are inevitable. Current workforce roles were designed in the days of the horse and buggy. The choice to update them should be easy. It means more and better care, more rewarding jobs for hospital professionals and a more sustainable system