Data from a variety of sources contributes to HWNZ’s ability to amalgamate information about the workforce and the environment it operates in, and from there to identify trends. Such data underpins our ability to carry out workforce modelling and to gauge the impact of demonstrations such as new roles or models of care.
Inaccurate and unreliable data collections have been an issue across the sector for some time now. HWNZ has access to better data than ever before – data that compares favourably to that available in other countries. However, still more is needed. Data about each individual in the workforce is important for forecasting, and to identify where there are shortcomings in workforce distribution.
Patient data collected by the Ministry is detailed and accurate, but information about the main occupational groups in the workforce is of variable quality. Issues include data that is summarised, inconsistent, out-of-date or collected ad hoc. Data quality and quantity also varies by profession. Information about aged care workers and others in the non-regulated workforce is particularly scarce.
Lack of detail in current workforce data sets provided by DHBs and regulatory authorities, and difficulties pertaining to the alignment of this data, impede our ability to carry out workforce modelling and to gauge the success of interventions.
HWNZ aims to set up a master workforce database to be used across the sector, comparable in its level of detail to that currently available for patient data. Such a database could be used to generate detailed reports for workforce forecasting purposes. It would not involve the disclosure of information that might impact on the privacy of individuals.
Workforce planning cannot rely on data crunching alone. Economic and social trend analysis is also vital, as is preparing for changes resulting from technological advances. Together with HWNZ’s forecasting, these activities form a broad and comprehensive source of workforce intelligence for analytical purposes.
Demonstrating innovative roles
A flexible workforce is better able to meet the needs of the public. So over the past five years, HWNZ has funded demonstration sites to investigate whether new roles and extended scopes of practice can improve service delivery. The term ‘demonstration site’ refers to a DHB or GP practice where an innovative change in practice is explored on a small scale. These arise from sector initiatives, open tenders, HWNZ’s Workforce Service Forecasts and Ministry programmes.
Some of the roles trialled have already been developed and implemented in other countries. What we are testing is their potential to add value to integrated teams of health practitioners working in New Zealand settings.
Priorities for demonstration projects are services that cater for long-term conditions, mental health and older people. For example, HWNZ supported a demonstration of nurse practitioners who worked with aged care residential facilities. This was a locally proposed response to GP shortages in the MidCentral region.
The roll-out of innovative roles has had mixed results. Embedding innovations more widely is one of HWNZ’s next challenges. So too is tapping into the sector’s enthusiasm for change and providing support for initiatives that do things differently. More can be done to create new models of community- based care and to enhance the potential of the non-regulated workforce.
A number of innovations have been expanded or extended after successful demonstrations. For example, the Lower North Island Palliative Care Managed Clinical Network now has a three-year contract to continue its work to improve access to palliative care closer to home. The network is made up of three DHBs – Capital & Coast, Hutt Valley and Wairarapa – and Te Omanga and Mary Potter Hospices.
Table 1: Examples of demonstrations supported by HWNZ
* Some of these are new roles; others are new to New Zealand.
+ Agility TRx is an electronic tool that gives district nurses remote access to patient information and allows them to make changes to home visit schedules.
Demonstrations involving nurses have been shown to improve patient care and to open new career pathways within the profession. For example, diabetes nurse prescribers improve continuity of care for patients, reduce the need for separate appointments for routine prescriptions and reduce the time doctors spend on routine diabetes appointments. Most diabetes nurse prescribers currently work in secondary services; there will be an effort to increase the number working in primary care, consistent with the principle of delivering services closer to home.
Rehabilitation services are the focus of several demonstrations in Palmerston North. The Universal College of Learning (UCOL) offers a new postgraduate diploma for clinical exercise physiologists, who work with referred hospital patients with chronic conditions compounded by lifestyle factors. The tailored exercise programmes they create result in improved respiratory function, weight loss and lifestyle changes for patients. Although clinical exercise physiologist is an established role overseas, it is new to New Zealand.
In another demonstration, UCOL also runs an in-home programme to help older people regain mobility, in partnership with Lavender Blue Nursing and Home Care Agency. Sports science and exercise students from the college gain work experience through this programme.
More information about current and established innovations is available at www.health.govt.nz.