Core health service sustainability requirement | Threats to service sustainability | Impact of threats on sustainability | Elmore health service responses and outcomes |
---|---|---|---|
Addressing EXTERNAL threats to environmental enablers | |||
Supportive policy environment | Changes in IMG legislation/regulations | • Recruitment and appointment process for IMGs is more difficult | • Targeted recruitment of potential doctors by EPHS staff • Greater dependence on assistance of Rural Workforce Agency Victoria (RWAV) |
 | • Changes in funding arrangements (e.g. after-hours services) | • Affects total amount and mix of funding available to service | • Broaden income base through more education and training, research and incentive funding |
 | • Changes in government funding schedule and service indicators | • Attempts by government to reduce the 'red-tape' requirements have complicated service performance monitoring and associated quality improvement | • Strengthen link with research evaluation team to identify and maintain sentinel indicators for measuring performance |
Clearly-articulated Federal-State roles and responsibilities | • Announcement of nation-wide orientation to PHC models and organisations (Medicare Locals) | • Implementation distracting service staff and workforce agencies from 'core business' | • Service is positioning itself with key agencies and authorities to maintain its role and visibility in new regional organisational arrangements |
Strong community involvement | • Changing demography; impact of natural disasters (floods, bushfires) in the catchment area | • Population change due to ageing and in- and out-migration make it difficult to engage broad population in early intervention and results in need for different services | • Establishment of a single-point-of-entry to comprehensive PHC ensures access to the range of integrated services providing acute and chronic care, health promotion and disease prevention • Regular consultation with community about service changes |
Addressing INTERNAL threats to service sustainability requirements | |||
Workforce supply and mix | • Rapid expansion of EPHS catchment (i.e. into surrounding regions: 'hub-and-spoke' model of visiting services and establishment of permanent services in surrounding region) | • Risk of expansion beyond workforce capability and service capacity, high cost of ongoing recruitment | • Targeted recruitment ensures prospective staff are well-matched to service • Use of one doctor to provide locum relief across all sites |
 | • Ongoing dependence on IMGs | • Risk of short length of stay and need to re-recruit as IMGs relocate to metropolitan areas for cultural and family reasons | Staff retention maximised by: • Good matching of recruits to the service • Strong supervision and support for continuing professional development • Capitalising on the full range of workforce incentives • Critical mass of GPs means after-hours work is not too demanding and enables part-time work • Multidisciplinary teamwork reduces isolation and workload |
 | • Growth of GP 'superclinic' in nearby large regional centre [23] | • May provide a more attractive alternative practice location for doctors | • Existing service maintains comprehensive whole-of-patient and community care activities that provide many professional opportunities and career satisfaction |
 | • Older staff seek retirement or career change | • Need for pro-active succession planning to minimise impact of loss of experienced staff | • Links to Monash University and RWAV as a teaching practice for medical students and registrars • Proactive succession planning |
i. Linkages | • New leadership and change within partner organisations and government authorities | • Established relationships can be threatened by new arrangements that do not meet local needs and the complex public-private mix of services, ownership and investment arrangements | • Close collaboration with partners and ongoing involvement with established research team |
ii. Infrastructure | • Infrastructure renewal required to accommodate organisational change and additional services | • Remodelling existing 'hospital' infrastructure can result in perceived 'loss' of services by some community residents | • Capitalising on infrastructure grants (e.g. new payment facilities, remodelling of infrastructure and 24/7 emergency care) |
iii. Funding | • Dependence on fee-for-service funding and high level of bulk-billing • Changes to funding arrangements for after-hours service | • Diversification of financial sources required to ensure viability (i.e. total funding and blended-payment funding) | • Service capitalises on full range of financial incentives on offer (e.g. additional funding for after-hours service) |
 | Alternative services available in surrounding communities | • Patient attrition (e.g. following "usual doctor" to another practice, minimising the distance travelled by 'one-stop-shopping' in larger centres) affects income stream | • The comprehensive integrated range of services minimises patient leakage and maximises practice income |
iv. Governance leadership and management | • Leadership changes (e.g. principal GP expands practice to other towns; new Chief Executive Officer recruited to key partner organisation [BCHS]) | • When organisational leaders reduce or withdraw their services, the community may experience a sense of "loss" and perceive the quality of the services to have declined • Potentially weakened relationships between key partners | • The need for pro-active leadership succession planning within the health service is recognised • Mentoring new staff for clinical leadership roles • Practice manager shares expertise with and devolves responsibility to other administrative staff • Use new developments (e.g. building works) as an opportunity to revitalise relationship with key partners and extend opportunity for joint service provision |