AustralianHealthCareSystemCode

AustralianHealthCareSystem
Betterbodyz
11
Part 2

The Code of Conduct contains four ethics principles. The model (below) is broken into
quarters
The four principles are:
• Commitment to the system of government
• Accountability and transparency
• Integrity and impartiality
• Promoting the public good
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Commitment to the system of government
We commit to working impartially and professionally within the three tiers of government –
Local, State and Commonwealth governments.
We operate within government guidelines to implement public sector priorities, policies
and decisions.
Accountability and transparency
We act with care, diligence and attention and commit to providing the highest level of
service and standards to the Queensland people.
We ensure that public resources and information are managed in an effective and
accountable way.
We take responsibility for our actions and decisions and ensure that they can be explained
and easily understood.
Integrity and impartiality
We make decisions in our work and provide advice after reviewing all relevant information,
making sure that our decision is objective, honest, fair, impartial, apolitical and timely.
We treat people with respect, courtesy and sensitivity and recognize their rights, safety and
welfare.
3

Promoting the public good
We respond to both government requirements and engaging and working with the public to
implement public sector priorities, policies and decisions.
As public sector employees we need to ensure that resources (funded by public monies)
are managed and accessed efficiently, economically and effectively.
In addition to the Code of Conduct a number of other elements also guide us in ensuring we
act with integrity and accountability.
These include:
• declaring conflicts of interest
• declaring gifts and benefits
• reporting wrong doing (PID)
• fraud and misconduct
• Queensland Health and Queensland Government values.
4

The professional bodies and regulatory bodies in Australia?
Regulatory Bodies are for example the Australian Health Practitioner Agency (AHPRA) and
the National Boards, like the Nursing and Midwifery Board of Australia (NMBA). AHPRA is the
organization responsible for the implementation of the National Registration and
Accreditation Scheme across Australia. At the moment, there are 14 professions regulated
under this scheme and each has a national board, like the NMBA, that is responsible for the
regulation of their profession.
The primary role of those Boards is to protect the public. APHRA supports the National
Boards, handles complaints, manages the accreditation of overseas trained professions.
The National Boards develop national registration and accreditation standards, are
responsible for the accreditation of educational programs, develop standards, codes and
guidelines, registering practitioners as well as students.
Professional Bodies support the practitioner. For example, the Australian Nursing and
Midwifery Federation (ANMF). Those bodies are there to support their members.
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The contemporary trends for the health workforce in Australia are that:
About 10 years ago professional regulation was about protecting a professional title and
stopping people getting into the profession. At today, the role of regulating authorities
(AHPRA, NMBA…) is to protect the public, to do so they establish guidelines and code of
conducts. These are setting boundaries on the professions as it is regulated what they are
allowed to do and not, for example a doctor prescribes medications, and nurses administer
them. Also, GP’s are the gate keepers, people have to see their GP first to get the entry to a
specialist.
Health professionals just to train and work uni-disciplinary, at the moment most facilities
work in multidisciplinary teams, which means that the different disciplines approaching
the patient from their perspective and are working parallel to each other. The trend is
towards a client centred care, where the client is the leader of the team and the different
professionals work interdisciplinary, which means they work together and develop ONE
care plan for the client.
The workforce used to be very hierarchical, with a great medical dominance. This is still the
case in some institutions but the trend is towards a less hierarchical workface.
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The benefits and challenges of having diverse health workforce for service provision and
continuity of care in Australia?
The benefits are that every profession is highly qualifies in their profession, in their scope
of practice, therefore the patient receives a high standard of care and services.
The challenge is that the professionals need to communicate very well with each other to
provide good care. Also, if the professions are not located in the same institute, the client
might have to travel a lot and pay money to different providers. Additionally, each
profession has its boundary’s, what they can do and for what they have to send the client to
a different profession.
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The benefits and challenges of working in different types of health care teams in different
setting?
Uni-disciplinary team these teams are made up of many providers from the same
background, for instance all nurses. The benefits are that all team members share the same
professional skills and training speak a common language of healthcare and function in the
same role within the group.
The challenges are that they can only work in their scope of practice and have to send their
clients to a different institution to receive services from a different profession.
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setting?
Interdisciplinary teams consist of different professions that work in collaboration to
develop a care plan for their patients. In this team the patient receives the best care. The
challenges are time; as all professions have to come together at the same time to
communicate the single cases.
Multidisciplinary teams are unable to develop a cohesive care plan as each team member
uses his or her own expertise to develop individual care goals. In contrast, each team
member in an interdisciplinary team build on each other's expertise to achieve common,
shared goals.
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setting?
Necessity of interdisciplinary team work
The need for interdisciplinary team work is increasing as a result of a number of factors
including:
(1) an aging population with frail older people and larger numbers of patients with more
complex needs associated with chronic diseases;
(2) the increasing complexity of skills and knowledge required to provide comprehensive
care to patients;
(3) increasing specialization within health professions and a corresponding fragmentation
of disciplinary knowledge resulting in no-one health care professional being able to meet
all the complex needs of their patients;
(4) The current emphasis in many countries’ policy documents on multi-professional team
work and development of shared learning;
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setting?
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Climate • Interprofessional atmosphere • Team culture • Trust
• Valued contributions • Nurturing consensus • Participative safety
• Personal qualities
Communication • Formal/Informal structures • Completion/Reading care plans • Use of shared case notes
• Intra-team communication • Regular case conferences
Individual characteristics • Knowledge/experience • Interpersonal team relationships • Common goals
• Interpersonal skills • Listening skills • Different opinions/perceptions
• Personal characteristics • Understanding own role/others
roles
• Exploring/Acceptance role overlap
Interdependence • Mutual support • Willingness to share • Professional synergy
• Reciprocity within team • Team relationships
Leadership • Role of physicians •Need for chairperson role
Learning • Action based learning • Nurturing a learning culture • Training within clinical teams
• Interprofessional learning
Patient focus • Patient centeredness • Outcomes focus • Team care planning and discussion
• Holistic care • Timely interventions • Impacts of reduced contact time

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Perceptions • Differing perceptions of own role, others roles, team
work
Power • Equality of relationships • Hierarchical/traditional role of medicine • Assertiveness/confidence
• Power/Status • Reluctance to voice opinions • Scapegoat (Victimization)
Problem
solving/decisionmaking
• Proactive approach
• Creativity
• Physician role
Professional commitment • Professional identity • Professional jargon • Tensions/rivalry
• Role expectations • Knowledge/skills • Jealousy
Roles • Autonomy • Role enactment • Role boundaries/delineation/
• Role modeling • Role clarity decision making
Skills • Core professional competencies, skills, tasks • Sharing of knowledge/
information/skills
• Differing levels of skill acquisition
Structures • Organizational factors • Goal planning • Time
• Team building • Common location • Team meetings/case conferences
Team characteristics • Capacity • Size • Accessibility after hours
• Dynamics/Balance • Membership
Values • Philosophy • Shared goals/objectives • Practice context
• Staff commitment • Positive attitude

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Characteristics of a “good team” as identified by
team members
1. Good communication Communication primarily referred to intra-team communication and included team members feeling as though they could listen as
well as speak out within a team context; and the ability to discuss and resolve difficulties within the team. It was suggested that being
part of a large team hinders good communication by limiting the “two-way” communication, and that some peoples' views do not
travel “upwards”.
2. Respecting/understanding roles Importance of respecting and understanding the roles of other team members; that the limitations and boundaries of each role
were well understood; and to have an understanding of how the roles have the potential to impact on patients. Practitioners should
also be aware of how their own role fits within the team, and differs from that of other team members, and that roles and
responsibilities are made explicit.
3. Appropriate skill mix Skill mix refers to the mix and breadth of staff, personalities, individual attributes, professions and experience. Teams value
diversity, and clearly need input from a range of staff who bring complementary experience and attributes to the team. Teams also
felt that it was important to have the full complement of staff.
4. Quality and outcomes of care Ensuring the quality and outcomes of care was identified as an important component of a good team and includes several
reflective mechanisms both within and external to the team. Teams emphasized the importance both to have systems for capturing
their effectiveness (such as measuring patient outcomes); and to meet their targets. This included suggestions that teams are able
to reflect; accept criticism and act on it; have defined outcomes; follow-up patients; provide feedback to other services (for example,
on appropriateness of referrals and timeliness and appropriateness of information provided); and celebrate their own successes; and
clinicians keeping their skills up to date.
5. Appropriate team processes and resources This theme includes access to sufficient physical resources (office space, parking, computers); privacy to make confidential phone
calls; appropriate and efficient systems and procedures, including induction processes, policies, and paperwork that serves the need
of the service whilst avoiding duplication.
Workload management, having enough time to do the job, and time management were highlighted by several teams. Finally, the
pathway for patients, and the integration of the team with wider services was seen as an important procedural issue.
6. Clear vision Participants identified the need for a clear vision, role and purpose of the team. This was both to steer the direction of the team, but
also required so that teams could establish appropriate referral criteria into the team.

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7. Flexibility (of the team and the individuals
within it)
The need for flexibility was identified as an individual attribute “ability to cover each other’s roles, but knowing your
boundaries”.
Individuals also need to be flexible to respond to the constantly changing service environment and patient needs (for
instance,
flexibility of working hours). Flexibility of the service was also identified, for instance, flexibility in referral criteria.
8. Leadership and management All teams identified the importance of good leadership, and the characteristics of a good leader are explored elsewhere.
9. Team culture: camaraderie and team
support/relationships
The importance of team culture was the largest theme, with 66 items within this theme. Trust, mutual respect, reliability,
commitment and support were the most commonly raised themes. But team culture included the importance of informal
relationships, camaraderie, fun, and friendship between colleagues.
10. Training and development opportunities Opportunities for gaining new knowledge, sharing knowledge, continuing professional development, and education.
11. External image of the service The importance of the external image of the service was raised by half of the teams and included the physical presentation of the
staff (that is, whether or not they wear uniforms); the external image portrayed to outside agencies through their external points of
contact (for instance phone systems that do not work properly); the external marketing of the service, which is important for
managing referrals and the workload of the team.
12. Personal attributes Several personal attributes were identified as being important to having an excellent team. These included approachability,
appropriate delegation, being able to compromise, confidentiality, decisiveness, empathy, good organisation skills, initiative; knowing
ones strengths and weaknesses; open to learning; acquiring, demonstrating and sharing new skills and knowledge, patience,
personal responsibility, protective, reflexive practice, tolerance
13. Individual rewards and opportunity Participants identified the importance of the individual returns on team work, which included good financial rewards; opportunities
for career development; autonomy; challenge within the role and the opportunity to think outside the box.

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Code name / Challenges Code description Inclusion Exclusion
Clarity of vision, uncertainty and
Changes to service
The extent to which values are shared by team
members including goals and objectives of the
team and definitions of the service.
Including uncertainty at strategic level,
external pressure to change and ways of
managing change.
Excluding issues around clear delineation
of individual roles and better
understanding of others'
Roles/professions (5).
Excluding individual goals (6).
Communication and
relationships-external
Communication and relationships with external
organizations/services and senior management.
Knowledge of other services. Including
external factors which affect the team and the
influence of the team on external services and
organizations.
Excluding issues related to change and
uncertainty (3).
Communication and relationships-
internal
General team relationship and communication
issues.
Including team integration, clear knowledge of
others' roles and meetings.
Excluding joint working, sharing skills &
knowledge and reflective practices (8).
CPD, rotation and career progression Activities aimed at professional development:
training, knowledge, skills, rotation,
secondment and opportunities for promotion
and progression.
Including individual goals and personal
issues, for example, anxiety and self-worth.
Facilities, resources, procedures and
administration
Issues relating to facilities, resources and
working practices and procedures.
Excluding capacity/team size, workload & t
time-management (11).
Joint-working Activities related to staff members working
together and observing each others’ work.
Including joint visits and assessments and
shadowing opportunities.

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Management, leadership, decision-
Making and autonomy
Explicit mentions of managers and
management or leaders
and leadership and euphemisms
(for example. higher level), especially
regarding
decision making and coordination.
Includes processes of decision making
within
the team including decisions being made
by
Superiors and having autonomy to make
own
decisions
Excluding issues covered by other
codes
for example, working procedures (7),
staffing levels (11), clarity of goals (3),
communication (4 and 5), de-briefing
-procedures (13) and so on.
Morale and motivation Issues reported to positively or negatively
affect the morale of team members.
Including motivation, job satisfaction,
enjoyment, pride and so on.
Patient treatment, communication,
capacity and outcomes
Referral procedures/criteria, capacity and
demand issues.
Including patient interventions and
outcomes, and measurements of
effectiveness.
Including throughput of patients, care-needs,
issues of workload and time-management.
Including communication and relationships
with patients and family members.
Excluding communication and
relationships with external services and
organizations (4).
Role mix, professional roles and
responsibilities
Issues regarding the variety of roles and
distribution of responsibilities currently within the
team.
Including the balance between maintenance
of professional roles and the need for generic
working.
Excluding professional development
(6) or service development activities (that
is, developing/
Excluding team size (11), team distributing skills and knowledge) (13).
work issues (5). Excluding lack of clarity of roles (5).
Excluding functions ordinarily performed by
external services (4).
Service development activities Service development and team building
activities.
Including case reviews and other reflective
practices (for example, de-briefing
procedures).
Including specific skill development across the
team (for example, supporting changing roles).

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Data synthesis
Characteristics of a good
interdisciplinary team
Data sources
Themes from thematic
synthesis of the literature
Themes identified as characteristics of a good team
from IMT workshops
Topics identified by participants as challenges to
interdisciplinary team work from IMT workshops
Communication Communication Good communication Communication and relationships-external
Individual characteristics Individual characteristics
Problem solving/ decision-making
Interdependence
Personal qualities
Leadership and
management
Leadership Leadership and management Management, leadership, decision-making and
autonomy
Personal rewards, training
and development
opportunities
Learning Training and development opportunities Continuing professional development, rotation and
career progression
Individual rewards and opportunity Morale and motivation

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Quality and outcomes of care Patient focus Quality and outcomes of care Patient treatment, communication, capacity and outcomes
Appropriate skill mix Skills
Team characteristics
Appropriate skill mix Role mix, professional roles and responsibilities
Appropriate process and
resources
Structures Appropriate team processes and resources Facilities, resources, procedures and administration
Team climate Climate Team culture Communication and relationships-internal
Respecting and understanding
roles
Power Respecting and understanding roles Joint working
Perceptions
Roles
Role mix, professional roles and responsibilities
Clarity of vision Values Clear vision Clarity of vision, uncertainty and changes to service
Professional commitment External image of the service
Flexibility

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Themes Description Characteristics of a good interdisciplinary team
1. Leadership and management Having a clear leader of the team, with clear direction and management; democratic; shared power; support/ supervision; personal
development aligned with line management; leader who acts and listens.
2. Communication Individuals with communication skills; ensuring that there are appropriate systems to promote communication within the team.
3. Personal rewards, training and
development
Learning; training and development; training and career development opportunities; incorporates individual rewards and opportunity,
morale and motivation.
4. Appropriate resources and procedures Structures (for example, team meetings, organizational factors, team members working from the same location). Ensuring that appropriate
procedures are in place to uphold the vision of the service (for example, communication systems, appropriate referral criteria and so on).
5. Appropriate skill mix Sufficient/appropriate skills, competencies, practitioner mix, balance of personalities; ability to make the most of other team members'
backgrounds; having a full complement of staff, timely replacement/cover for empty or absent posts.
6. Climate Team culture of trust, valuing contributions, nurturing consensus; need to create an interprofessional atmosphere.
7. Individual characteristics Knowledge, experience, initiative, knowing strengths and weaknesses, listening skills, reflexive practice; desire to work on the same goals.
8. Clarity of vision Having a clear set of values that drive the direction of the service and the care provided. Portraying a uniform and consistent external
image.
9. Quality and outcomes of care Patient-centered focus, outcomes and satisfaction, encouraging feedback, capturing and recording evidence of the effectiveness of care
and using that as part of a feedback cycle to improve care.
10. Respecting and understanding roles Sharing power, joint working, autonomy.

Multidisciplinary teams consist of different professions that work parallel, like in a
hospital. Rehabilitation. The benefits are that the client Is in one institute but receives a
range of different services. The challenges are that these teams are working parallel with
each other, every discipline approaches the patient from their own perspective.
Multi-disciplinary care involves a range of professionals and commonly includes medical,
nursing and allied health professionals. Multi-disciplinary care has been demonstrated to
improve outcomes especially for patients with chronic illnesses.16,38 Key to the primary
care reform under the GP Super Clinics Program was improved care and outcomes for
people with or at risk of a chronic illness, and for older people.
High quality chronic disease management requires “a longitudinal and preventive
orientation manifested by well-designed, planned interactions between a practice team
and a patient in which the important clinical and behavioral work of modern chronic illness
care is performed predictably”. Ideally, this requires an integrated and coordinated
approach by a multi-disciplinary care team with regard to assessment, treatment, support
for self-management and follow-up
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The elements required for effective and integrated models for multi-disciplinary care
include flexibility and cooperative team-work with a clearly identified coordinator and
supported by effective communication processes.
The provision of multi-disciplinary care alone within a single practice will not ensure that
care is integrated for patients across the discipline spectrum. The challenges facing most
modern health care systems require integration between the elements of health care in
order to meet patients’ needs, particularly those with chronic illness.
Integrated care is defined as patient care that is “coordinated across professionals,
facilities, and support systems; continuous over time and between visits; tailored to the
patients’ needs and preferences; and based on shared responsibility between patient and
caregivers for optimizing health.” Promoting the concept of integrated care assumes that
patient experiences and outcomes are better under models where care is integrated
among systems, facilities and clinicians.
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integrated care goes beyond the sharing of information, such as provided through a shared
electronic health record.46 It needs to be complemented by formal and informal
relationships among disciplines to support communication, and by shared care planning.
Mechanisms which have traditionally been applied to support integrated care, but were
less than optimal, have been sharing of written patient records, informal communication
within practices, referral letters and visit summaries with providers external to the
practice.
The GP Super Clinics are implementing multi-disciplinary care especially for patients with
chronic illnesses. That is, patients are receiving aspects of their care from multiple
disciplines. The high level of positive patient experience in relation to the care provided at
the GP Super Clinics is an indication of contribution to patient need. In most but not all
instances, this care was integrated within the GP Super Clinic setting. The co-location of
multiple disciplines under one roof and the shared electronic health record were perceived
as major contributors to integration.
The extent to which the models of multi-disciplinary care were evidence-based was not as
obvious. Co-location and a shared health record alone may facilitate, but do not constitute,
multi-disciplinary care. Indeed, there is a risk that in the absence of a greater focus on
applying evidence-based guidelines which reflect the multi-disciplinary nature of care,
health outcomes which are expected to accrue from this type of model of care may be less
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Results vs Ego/status
A team that is not focused on results
-Stagnates & fails to grow
-Rarely defeats competitors
-Loses achievement-oriented employees
-Encourages team members to focus on their own careers and individual goals
-Is easily distracted
A team that is focused on results
-Attracts and retains achievement-oriented employees
-Minimizes individualistic behavior
-Enjoys success & suffers failure acutely
-Benefits from individuals who subjugate their own goals / interests for the good of the
team
-Avoids distractions
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Accountability vs Low/average standards
A team that avoids accountability
-Creates resentment amongst team members who have different standards of performance
-Encourages mediocrity
-Misses deadlines & key deliverables
-Places an undue burden on the team leader as the sole source of discipline
A team that embraces accountability
-Ensures that poor performers feel the pressure to improve
-Identifies potential problems quickly by questioning one another’s approaches without
hesitation
-Establishes respect among team members who are held to the same high standards
-Avoids excessive bureaucracy around performance management and corrective action
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Commitment vs Ambiguity
A team that fails to commit
-Creates confusion amongst the team about direction & priorities
-Watches windows of opportunities close due to excessive analysis & unnecessary delay
-Breeds lack of confidence & fear of failure
-Revisits discussions & decisions again & again
-Encourages second guessing among team members
A team that commits
-Creates clarity around direction and priorities
-Aligns the whole team around common objectives
-Develops an ability to learn from mistakes
-Takes advantage of opportunities before competitors do
-Moves forward confidently
-Changes direction without hesitation or guilt
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Conflict vs Artificial harmony
Teams that fear conflict
-Have boring meetings
-Create environments where ‘white-anting’ and personal attacks thrive
-Ignore controversial issues that are critical to team success
-Fail to tap into all the opinions & perspectives of team members
-Waste time and energy with posturing & interpersonal risk management
Teams that engage in conflict
-Have lively and interesting meetings
-Extract & exploit the ideas of all team members
-Solve real problems quickly and from root causes
-Minimize politics by always going back to the source of any gossip or criticism
-Put crucial topics on the table
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Trust v Invulnerability
Distrusting team members
-Conceal weaknesses & mistakes
-Hesitate to ask for help
-Hesitate to offer help outside own area
-Jump to conclusions about intentions & aptitudes of others without clarifying
-Fail to recognize & tap into another’s skills & competencies
-Waste time & energy managing their behaviors for effect
-Hold grudges
-Dread meetings and find reasons to avoid spending time together
Trusting team members
-Admit weaknesses and mistakes
-Ask for help
-Accept questions & input about their areas of responsibility
-Give each other the benefit of the doubt
-Take risks in offering feedback & assistance
-Appreciate & tap into each other’s skills
-Focus time & energy on important issues rather than politics
-Offer & accept apologies without hesitation
-Look forward to meetings & other opportunities to work as a group
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Examples of core and specialist roles/skills
Core (shared)
-Intake assessment
-Assessment of mental state and risk
-Care planning
-Interagency liaison
-Counselling
-Case management
-Family work
-Psycho education
-Relapse prevention planning
-Documentation
Specialist
-Family therapy
-Cognitive behavioral therapy
-Community development
-Medication prescription
-Medication administration
-Skills training
-Group work
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Discipline/Specialist skills
Consumer provider
-Experiential knowledge
-Provision of support from people who have “been there too” (Bland, et.al., 2007)
-Self help groups
-Role models who may provide a renewed sense of hope
-Carer provider
Experiential knowledge
-Provision of support from people who have “been there too” (Bland, et.al., 2007)
-Self help groups
-Knowledge of services and supports for families
-Mental health nurse
Administration of prescribed medications
-Expertise in creating and maintaining a safe environment for treatment and care
-Nurse practitioners (developing role in some states) – prescribing of some medications,
ordering
of diagnostic and clinical tests, specialist referrals, admission rights and authouizing
absence
from work (sick certificates)
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Occupational Therapist
-Enabling participation in occupation – self care, leisure, and productivity
-Skills training
-Adaptive strategies and environmental accommodations to facilitate occupational
participation
-Group work
Psychiatrist
-Medical expert (assessment, investigation, prescribing)
-Medico-legal signatory
-Diagnosis and formulation
Psychologist
-Psychometric assessment (diagnostic, IQ, personality and neuropsychological function)
-Cognitive behavioral therapy
-Skills training
-Behavioral consultant
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Social worker
-Emphasis on social context and consequences of illness
-Advocate for social justice – human rights, access to resources
-Intensive family casework
-Focus on connections between individuals, groups and organizations
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Social worker
-Emphasis on social context and consequences of illness
-Advocate for social justice – human rights, access to resources
-Intensive family casework
-Focus on connections between individuals, groups and organizations
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Transdisciplinary
A transdisciplinary approach yields different results than interdisciplinary approaches
because it requires each team member to become sufficiently familiar with the
concepts and approaches of his and her colleagues as to blur the disciplinary bounds and
enable the team to focus on the problem as part of a broader phenomena.
As this happens, discipline authorization fades in importance and the problem and its
context guide an appropriately broader and deeper analysis.
A transdisciplinary team is an interdisciplinary team whose members have developed
sufficient trust and mutual confidence to engage in teaching and learning across
disciplinary
boundaries. In addition to collaborating, team members entrust, prepare, and supervise the
sharing of disciplinary functions while retaining ultimate responsibility for services
provided in their
place by other team members.
Disciplinary lines are blurred, and team members share role functions to a high degree.
This model does not have wide application in geriatric settings because patients generally
need the special skills of each discipline, obtained through extensive specialized training,
not just generic skills that many disciplines might share.
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Transdisciplinary
Emphasis is on sharing the team responsibilities. A “manager,” one member of the team, is
appointed with the task of coordinating the activities of the various professionals who
make
up the team. This manager often carries out the recommendations of the team, doing so
with full support of the team.
Members teach each other both the knowledge and skills from their respective disciplines
that will be required for effective team decision-making and implementation of those
disciplines.
When two or more professionals work together in the evaluation, they may instruct each
other in the knowledge and skills of their respective disciplines to such a degree that each
may then
function adequately in the other’s role when necessary.
The transdisciplinary team approach is based on the premise that one person can perform
several professional roles by providing services to the patient under the supervision of
individuals from the other disciplines involved. This approach represents the concept of
the multi-skilled health practitioner
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It’s important to understand your own discipline as well as other disciplines to work
productively in health care teams?
To understand each other’s profession is very imported to achieve productive outcomes.
We have to know how to get into the team for the best care of a patient and we have to
acknowledge and value each other influence and work.
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What is a healthy work environment?
Why is it important for workers and clients?
A good workplace is a place where each worker values the other people, colleagues,
relationships and the viewpoints of others. It is a place where each worker demonstrates
respect, trust and collaboration.
Workers recognize and acknowledge each other’s contribution and open discussions and
communication is taking place. A healthy work environment is a safe place; it is
empowering and satisfying. It includes the elimination of hazards and the providence of a
certain degree of comfort, like proper sanitation, access to drinking water and sufficient
ventilation.
It also includes good support and access to education and professional development.
People who enjoy their job are likely to engage more thoroughly with their work and this
has effects on their clients.
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-A healthy work environment contributes to employee health
-A place of "physical, mental, and social well-being," supporting optimal health and safety
-A healthy Work Environment is one that is safe, empowering, and satisfying
-A healthy Work environment where there is good social support from colleagues and
managers and
access to education and professional development opportunities
-A healthy working environment where there is a balance between effort and reward
-A healthy working environment what gives professional identity of meaningful work
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-A healthy working environment enhance employee health
-A healthy working environment promotes productivity and work quality
-A healthy working environment where a health and safety procedure is in place for the health and
safety for the workers and clients
-A healthy working environment what is patient centered based with a sense of professionalism,
accountability, transparency, involvement, efficiency, and effectiveness to provide the best health
care for the client by providing sense of safety, respect, and empowerment to and for all persons.
-The workplace directly influences the physical, mental, economic and social well-being of workers
and in turn the health of their families, communities and society.
-A healthy working environment offers an ideal setting and infrastructure to support the promotion
of health for workers and patients.
-A health working environment enhances workers self-esteem, reduces stress, improves morale,
increases job satisfaction, increases skills for health protection, improves health and a sense of
well-being
-A healthy working environment contribute to work satisfaction, feeling supported, respected,
valued, understood, listened to, having a clear understanding of role, work equity and fair
compensation
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What are workplace health programs
Workplace health programs refer to a coordinated and comprehensive set of strategies
which include programs, policies, benefits, environmental supports, and links to the
surrounding community designed to meet the health and safety needs of all employees.
Examples of workplace health program components and strategies include:
-Health education classes
-Access to local fitness facilities
-Company policies that promote healthy behaviors such as a tobacco-free campus policy
-Employee health insurance coverage for appropriate preventive screenings
-A healthy work environment created through actions such as making healthy foods
available and
accessible through vending machines or cafeterias
-A work environment free of recognized health and safety threats with a means to identify
and address new problems as they arise
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Impact of workplace health programs
Workplace health programs can lead to change at both the individual (i.e., employee) and
the organization levels.
For individuals, workplace health programs have the potential to impact an employee’s
health, such as their health behaviors; health risks for disease; and current health status.
For organizations, workplace health programs have the potential to impact areas such as
health care costs, absenteeism, productivity, recruitment/retention, culture and employee
morale.
Employers, workers, their families and communities all benefit from the prevention of
disease and injury and from sustained health.
42

Building a workplace health program should involve a coordinated, systematic and
comprehensive approach
A coordinated approach to workplace health promotion results in a planned, organized, and
comprehensive set of programs, policies, benefits, and environmental supports designed to
meet the health and safety needs of all employees. A comprehensive approach looks to put
interventions in place that address multiple risk factors and health conditions concurrently
and recognizes that the interventions and strategies chosen influence multiple levels of
the organization including the individual employee and the organization as a whole.
Workplace health promotion programs are more likely to be successful if occupational
safety and health is considered in their design and execution, In fact, a growing body of
evidence indicates that workplace-based interventions that take coordinated, planned, or
integrated approaches to reducing health threats to workers both in and out of work are
more effective than traditional isolated programs. Integrating or coordinating occupational
safety and health with health promotion may increase program participation and
effectiveness and may also benefit the broader context of work organization and
environment
43

Step 1 - Workplace Health Assessment expanded
A successful workplace health program is one that is targeted to the specific employee
population, suiting the worksite, employee needs, and personal and organizational health
goals. This information can be gained through the first step in the process – a workplace
health assessment.
An assessment should aim to capture a picture of the many factors that influence employee
health including: individual level factors such as lifestyle choices, the work environment
(e.g, physical working conditions and social support), and the organizational level (e.g.,
culture, policies, and practices). This assessment can take place informally through
conversations, a call for input/opinions (such as a bulletin board, opinion box, email
requesting ideas), or more formally by using instruments such as an employee health
survey or environmental audit.
Both current health issues as well as employee interests should be considered when
prioritizing program and policy interventions as well as evaluating and making
improvements to the workplace health program on an ongoing basis. Involving employees
from the beginning will reinforce the shared responsibility and commitment the employee
and the organization have to employee health, and the overall success of the workplace
45

Step 2 – Planning the Program
The overall program requires a basic governance structure or infrastructure to administer and
manage health promotion activities which can be initiated during the planning phase and recognizes
the size and scope of each step may be influenced by factors such as the company’s size, sector, or
geographic location.
The enterprise governance structure provides the strategic direction, leadership, and organization
necessary to operationalize the program elements. Organizational strategies provide the
infrastructure to ensure program objectives are achieved, employee health risks are appropriately
managed, and the company’s resources are used responsibility.
Organizational strategies include:
-Dedicating senior leadership support to serve as a role model and champion
-Identifying a workplace health coordinator, council or committee to oversee the program
-Developing a workplace health improvement plan with sufficient resources to articulate and
execute goals and strategies
-Communicating clearly and consistently with all employees
-Establishing workplace health informatics to collect and use data for planning and evaluation
46

it is important to remember that a successful program does not necessarily incorporate all
potential workplace health strategies. A truly successful program is one whose
components are carefully selected, implemented efficiently, and is suited to the employee
population. It may be more prudent to focus on one or two policies/programs at first and
build on early successes rather than poorly implement several interventions at the
beginning.
Workplace health programs also do not have to cost significant amounts of money. Many
effective interventions such as health-related policy changes exist that are low-cost which
is especially important for small and medium sized employers who may not have lots of
resources to dedicate to employee health. The planning/workplace governance module
provides guidelines, tools, and resources for conducting a planning process.
47

Step 3 – Implementing the Program collapsed
Most employers, when they think about improving worker health, think of actions
individuals can take. Losing weight, quitting smoking, and exercising more are all examples
of individual actions that can result in better health. It is important to realize, however, that
improving health requires a broad perspective that also includes the environments in
which people work, live, and play. A person’s health is a result of both individual actions and
the context or environment within which those actions are taken.
Employers and employees have many opportunities to influence the work environment to
promote health and prevent disease. Changing the environment affects large groups of
workers simultaneously and makes adopting healthy behaviors much easier if there are
supportive workplace norms and policies. Therefore, it is important for the overall
workplace health program to contain a combination of individual and organizational level
strategies and interventions to influence health. The strategies and interventions available
fall into four major categories:
48

Step 3 – Implementing the Program collapsed
Health-related Programs – opportunities available to employees at the workplace or
through outside organizations to begin, change or maintain health behaviors
Health-related Policies – formal/informal written statement that are designed to protect or
promote employee health. They affect large groups of employees simultaneously
Health Benefits – part of an overall compensation package including health insurance
coverage and other services or discounts regarding health
Environmental Supports – refers to the physical factors at and nearby the workplace that
help protect and enhance employee health
The implementation module provides topic specific guidelines, tools, and resources for
putting the program strategies and interventions in place.
49

Step 4 – Determine Impact through Evaluation collapsed
Lastly, worksites should plan to evaluate the programs, policies, benefits, or environmental
supports implemented. It is important to assess how well the workplace health program
can be sustained over time, how it is received by employees and management, and its
return on investment (ROI).
While program evaluation is widely recognized as a core function of public health,
differences in definition of “good evaluation practice” often lead to evaluations that are
time-consuming and expensive, and, most importantly, produce findings that are not
employed for program improvement.
The evaluation should focus on questions that are relevant, salient, and useful to those who
will use the findings and that the evaluation process feeds into a continuous quality
improvement loop to improve and strengthen existing activities; identify potential gaps in
current offerings; and describe the efficiency and effectiveness of the resources invested.
The evaluation module provides general and topic specific guidelines, tools, and resources
for evaluating the program’s efforts.
50

Why is communication important for effective work relationships?
Good communication leads to an improved performance of the whole team and to an
increased job satisfaction. It also increases the quality of care for the clients. A team that
communicates effectively shows fever misunderstandings and a greater work efficiency.
To care effectively for a patient one profession needs to know what the other has planned
for the patient. If the doctor wants to see a patient dressing, he/she should communicate
this with the nurse so she/he can prepare the patient and plan time in to close the dressing.
Also, it would be ineffective doing the dressing change in time where the patient is planned
for physiotherapy.
Additionally, good communication during patient handovers is of utmost importance. ISBAR
is a recommended communication script for use in these situations. It stands for
Introduction: Name, age… of the patient
Situation: Clinical situation, issues, risks
Background: clinical history
Assessment: medical and other patient charts
Recommendations: for the shift
52

Good communication leads to an improved performance of the whole team and to an
increased job satisfaction. It also increases the quality of care for the clients. A team that
communicates effectively shows fever misunderstandings and a greater work efficiency.
To care effectively for a patient one profession needs to know what the other has planned
for the patient. If the doctor wants to see a patient dressing, he/she should communicate
this with the nurse so she/he can prepare the patient and plan time in to close the dressing.
Also, it would be ineffective doing the dressing change in time where the patient is planned
for physiotherapy.
Additionally, good communication during patient handovers is of utmost importance. ISBAR
is a recommended communication script for use in these situations. It stands for
Introduction: Name, age… of the patient
Situation: Clinical situation, issues, risks
Background: clinical history
Assessment: medical and other patient charts
Recommendations: for the shift
53

-Communication influences the quality of working relationships, job satisfaction and profound
impacts patient safety
-Communication for effective work relationship is important because it facilitates a culture of
mutual support
-Communication for effective work relationship minimizes misunderstandings and maximizes work
efficiency
-Communication for effective work relationship produces health working relationships, and allows
you and your colleagues to resolve issues in a collaborative manner.
-Good patient care is enhanced when there is mutual respect and effective communication
between all health care professionals involved in the care of the patient.
-Strong positive relationships between healthcare team member's communication skills and a
patient's capacity to follow through with medical recommendations, self-manage a chronic
condition , and adopt preventive health behaviors
-Communication for effective work relationship helps build and maintain strong relationships
between healthcare professionals and patients, and healthcare professionals
-Communication for effective work relationship improves coordination of care which leads to better
patient outcomes and improved practitioner compliance.
54

Effective patient communication in healthcare
Everyone has the right to be informed about the health services, costs and treatment options
available to them, and receive timely communication in a way they can understand.
Why is communication in healthcare important?
Effective communication between a health practitioner and their patient can improve overall
satisfaction and contribute towards better long-term health outcomes.
How well a patient understands the information provided can also have an impact on healthcare
decisions they might make in future. If a patient does not understand the information
they receive, there may be an increased risk of instructions being followed incorrectly, or an adverse
event occurring.
Communication issues are a common area of health service complaints , so it’s important for health
service providers to consider the communication needs of each patient and continually review their
communication approach.
55

Improving communication
According to the Australian Commission on Safety and Quality in Health Care, 60 per cent of
the
population has difficulty understanding complex healthcare concepts and information.
To help communicate as effectively as possible, health practitioners should:
recognize most people will be unfamiliar with healthcare information and address each
patient’s level of understanding
adopt a range of communication strategies
provide adequate information to patients in a compassionate manner
confirm that the patient has understood all the information provided
encourage patients to ask questions
undertake education to improve health literacy skills when communicating to patients.
56

How does power and medical dominance affect relationships in health care settings?
Medical dominance describes the power of the medical profession; the control over their
own work and the work of others, it influences resource allocations, policy making and the
way services are run. It is manifested through the professional autonomy of doctors, their
authority over other professions and their patients and sovereignty, not allowing boundary
crossing.
-Medical power and dominance over allied health occupational groups through
administrative influence, and through the collective influence of medical associations
-Relationships among clinicians in various occupations are mediated by the expectation
that
doctors assume responsibility for patient management and coordinating roles in health
care
teams, and the degree of acuity of particular health care settings.
57

Commonwealth/Federal Government
The Commonwealth or Federal Government’s main role is to fund the health system through
Medicare and write policies and regulations to help govern it. The government does this by
collecting analyzed data from various organizations, including the World Health
Organisation, and then deciding on how best to act on a national scale. It’s role is
essentially to direct and organise the health care system by coordinating between various
groups, including the various state governments.
Some Federal Government roles and responsibilities include:
-Writing national health policies
-Producing national health campaigns
-Providing funding for various health products and services (e.g. Medicare, Pharmaceutical
Benefits Scheme)
-Helping state government implement health promotions.
58

State government (New South Wales)
State governments are responsible to help in the development of policy, however, their
main role and responsibility is the implementation of health policies and the regulation of
health services in their state.
62

State government (New South Wales)
The NSW Ministry of Health is the ‘system manager’ for NSW Health, which coordinates 15
health districts, and “operates more than 230 public hospitals, as well as providing
community health and other public health services”. NSW Health includes:
NSW Ambulance – responsible for providing care in emergencies.
Health Infrastructure – responsible for the hospital building program.
HealthShare NSW – “provide high-quality shared services to support the delivery of patient
care within the NSW Health system.”
NSW Health Pathology – provides pathology, forensic and analytical science services.
eHealth – responsible for delivering Information Communication Technology (ICT) led
healthcare
Health Protection NSW – responsible for surveillance and response to infectious diseases.
63

Local government
Local government is your local council. The council’s roles and responsibilities include:
WHS monitoring
Waste removal (garbage & sewage)
Amenities
Town planning (roads, parks, etc)
Food safety
Councils are also involved in the collection of information, running some community health
groups and assessing local health needs.
64

Evidence-based policy is based on:
• Political knowledge
• Scientific (research-based) knowledge
• Practical implementation knowledge
Evidence-Based Policy
66

Bottom of Cliff-Medicine
-Pre-primary prevention/Public health
-Social-determinants of health
-Primary prevention
-Secondary prevention
-Medical care and tertiary prevention
67

Health Impact Pyramid-Counseling and Education
—Clinical Interventions
—Long-Lasting Protective Interventions
—Changing the context to make individuals’ default decisions healthy
—Socioeconomic factors (Increasing population impact/ Increasing Individual effort
needed
68

Acute Care Australia
Acute care is care which the primary clinical purpose or treatment goal to;
-Manage labor (obstetric)
-Cure illness or provide definitive treatment of injury
-Perform surgery
-Relieve symptoms of illness or injury (excluding palliative care)
-Reduce severity of an illness or injury
-Protect against exacerbation and/or complication of an illness and/or injury which could threaten life
or normal function
-Perform diagnostic or therapeutic procedures
71

Primary Health Care Australia
Primary care is typically the first health service visited by patients with a health concern. It includes
most health services not provided by hospitals and involves:
-A range of activities such as health promotion, prevention, early intervention, treatment of acute
conditions and management of chronic conditions
-Various health professionals such as general practitioners (GP), dentists, nurses, aboriginal
health workers, local pharmacists and other allied health professionals.
-Services delivered in numerous settings such as general practices, community health centeres,
allied health practices including physiotherapy and dietetic practices, health advice telephone
services, video consultations and remote monitoring of health metrics through electronic
devices.
72

Residential aged care is for older people who can no longer live at home.
Residential care refers to the care and services you receive when you are living in a care facility,
including aged care homes. Residential care is provided by Australian Government-approved
organisations to give you the care you need.
-Services provide continuous supported care ranging from help with daily tasks and personal care
to 24-hour nursing care
-Residential aged care is delivered to older people in Australia by service providers who are
approved under the Aged Care Act 1997.
-The department plays a vital role in developing policies, managing programmes and providing
regulatory services to improve the quality of residential aged care in Australian (agedcare, 2016)
73

Why you might need residential care?
You might consider residential care because:
-you might not be able to get out and about easily
-you may live on your own and want some extra company
-you may need help due to illness or disability
-you might need palliative (end-of-life) care.
You might still live in your own home with help from a carer, but need a short-term
residential care stay while your carer has a break. This is called residential respite care
and it can be on a planned or emergency basis.
74

How much will it cost?
The Australian Government pays the majority of aged care costs in Australia, but you will probably be
asked to contribute towards the cost of your residential care if you can afford it.
Aged care homes may charge a number of fees, such as:
-A contribution to expenses such as meals, laundry, heating and cooling, nursing and personal care
this is known as a basic daily care fee
-An extra contribution based on an assessment of your income and assets - this is known as a
means-tested care fee
-An accommodation payment - the Government may contribute to this, depending on your income
and assets fees for extra services which you request.
There are rules in place to make sure everyone receives the care they need.
75

Australia is home to a variable and complex health system which covers areas as broad-
ranging as primary care, acute care, palliative care, aged care, and community care. To
remain inclusive, it needs to be flexible enough to cater to factors such as dynamic cultural
diversity, rapidly changing socioeconomic, aging, gender and behaviural diversities and
which is why Australia needs and maintains broad coverage health care provisions.
77

Australian Healthcare System
78

-Sub-acute care is mainly driven by client’s functional status and quality of life with goal of
maximizing function. Sub-acute care is provided by health care teams with specialist health
professionals. Rehabilitation and palliative care fall into this category.
-Post-acute care refers to time-limited specialist care required by a person following an
episode of acute illness. It addresses the temporary health care needs of people during
their recovery from an acute illness, by providing continuity of care after they leave
hospital.
- Maintenance (or non-acute) care is care in which the primary clinical purpose or
treatment goal is support for a patient with impairment, activity limitation or participation
restriction due to a health condition. Following assessment or treatment, the patient does
not require further complex assessment or stabilization. Patients with a care type of
maintenance care often require care over an indefinite period (The Independent Hospital
Pricing Authority [IHPA]).
79

Impact of the changing population profile in Australia is likely to have on care
arrangements in the future?
Australia has a shift in population profile due to the aging population and a decline in birth
rates. A relatively large proportion of the population are considered aging population,
meaning they are over 65years old. As our health care system improves, so does the health
of the individual therefore people are living longer and requiring more care as they age.
This proposes an issue to the Australian government because of concerns related to costs
associated with maintaining health of our older population for longer periods of time. Costs
associated with hospitalization in particular, and aged care services such as residential
care are a considerable expense. As a result, the Australian government has implemented
new reforms to encourage older Australians to maintain independence in their own homes
and within the community.
The social model of health through the “living longer, living better” reform aims to provide
appropriate services to people within their communities and within their homes, and to
keep people out of costly residential care settings.
80

The major challenges faced by our health and social care systems?
· Aging population
· Increasing dependency profile of older people in care
· Tensions between regulatory and consumer demands
· Workforce shortages
An aging population will lead to a decline of active employees participating in the
workforce, therefore not contributing to the tax base – which pays for medicare.
Projected aging population increases demand for residential aged care facilities.
Those aged in the ‘old old’ category of the aging population have been shown to have a
higher rates of dementia and mental health challenges. This poses an important issue
when considering available services and dignified accommodation for both the mentally
impaired and competent older individuals. It is important to maintain appropriate
accommodation for both kinds of conditions to enhance well-being
81

Poor health in older Australians is disproportionally higher in priority populations such as
those in rural and remote areas, and indigenous people. These population groups can be
affected by social determinants including access to services, availability of family and
community support, and the cultural significance of taking up formal services.
Acute care in hospital settings is prevalent due to the individuals capacity for self-care and
participation in social life may be significantly compromised. As a result, the individuals
need for support and services may escalate leaving little or no other option other than
occupying hospital beds while they wait for residential care
Health workforce shortages proves a problem as graduate nurses or health care workers
have comparatively low pay, lack of career potential, de-skilling of professional nurses,
heavy workloads and little control over workload. Skilled and dedicated workforce has
diminished and a there is in an increase in VET training in this particular area.
82

Growing number of the aging population in Australia
83

The issue of balance in relation to the delivery of appropriate, cost-effective health care be
to all older Australians?
Spending on health is expected to steadily rise due to:
· Societal changes such as increasing age of population profile
· Increased prevalence of chronic disease
· Risk factors associated with chronic disease and aging
· New technological advances come with associated increase on spending on health.
In Australia, there is a shift in focus from older Individuals being dependant, fragile and
having poor health to encouraging and celebrating healthy, proactive and productive aging.
It shifts obligation for wellness to the individual. As a result older people are encouraged to
have more involvement in social and physical activities through specific health promotion
and community development programs.
Here lies the balance though, concerns have been raised as to whether it is sustainable to
continue to meet future health and social care needs.
84

The Australian Government aims to improve the health and wellbeing of Australians and to
reduce preventable mortality and morbidity caused by chronic disease, substance misuse
and other risk factors (such as tobacco use and dietary risks).
This will be achieved through evidence-based promotion of healthy lifestyles and good
nutrition, early detection of cancer and other lifestyle limiting conditions, and through the
implementation of strategies to reduce illegal drug use, tobacco use, the misuse of other
legal drugs and harmful levels of alcohol consumption.
Ongoing tobacco interventions are critical to ensuring that the prevalence of smoking in
Australia continues to decline.
86

A. Improving public health and reducing the incidence of chronic disease and
complications through promoting healthier lifestyles
Develop a reporting framework for the National Strategic Framework for Chronic
Conditions (the Framework) which is the overarching policy for the prevention and
management of chronic conditions in Australia. The Framework guides the development
and implementation of policies, strategies, actions and services to address chronic
conditions and improve health outcomes.
Operationalize the goals of the Australian National Diabetes Strategy 2016-2020 through
the development of an Implementation Plan. The Plan will guide Commonwealth and
State and Territory Government planning for diabetes prevention and management by
identifying priority actions and initiatives to ensure consistency and reduce duplication of
effort and investment.
89

B. Supporting the development of preventive health initiatives
Encourage and enable Australians to be physically active and consume a healthy diet
through the Healthy Food Partnership (the Partnership), which aims to improve the
nutrition of all Australians by making healthier food choices easier and more accessible
and by raising awareness of better food choices and portion sizes through programs
such as the Health Star Ratings system and the Australian Guide to Healthy Eating.
Encourage food reformulation in processed foods to enable consumers to have healthier
food choices through the Reformulation Working Group.
Continue the physical activity media campaign for girls and young women, ‘Girls Make
Your Move’, which is about inspiring, energizing and empowering young women and girls
aged 12–19 years, with a focus on those aged 15–18 years.
90

C. Improving early detection, treatment and survival outcomes for people with cancer
and supporting access to palliative care services
Continue to actively invite Australians to participate in cancer screening programs such
as the National Bowel Cancer Screening Program, the National Cervical Screening
Program, and the Breast Screen Australia Program, which increases the chances of
detecting cancer early and saving more lives.
Implement a single National Cancer Screening Register that will be fundamental in
supporting the renewal of the National Cervical Screening Program, and the expansion
of the National Bowel Cancer Screening Program. The transition to a National Cancer
Screening Register will be a key step towards connecting the health system and deliver
capability that can be used for future screening programs.
Continue to work with State and Territory Governments to implement the Medical
Services Advisory Committee’s recommendation to replace the current two yearly pap
test with a five yearly Human Papillomavirus test.
Support the provision of high quality palliative care in Australia through workforce
development, quality improvement and data development activities and supporting
advance care planning.
91

D. Reducing the harmful effects of tobacco use
Support the implementation of the National Tobacco Campaign to focus on high
prevalence groups, including Aboriginal and Torres Strait Islander peoples, people from
disadvantaged backgrounds and people in rural, regional and remote areas.
Evaluate the current mandated health warnings on tobacco products to inform the
Government on the effectiveness of graphic health warnings on tobacco product
packaging.
92

E. Preventing and reducing harm to individuals and communities from alcohol,
tobacco and other drugs
Finalize and implement the National Drug Strategy and the National Alcohol Strategy to
provide national frameworks for building safe, healthy and resilient Australian
communities through preventing and minimizing alcohol, tobacco and other drug related
health, social and economic harms among individuals, families and communities.
Ongoing implementation of activities under the National Ice Action Strategy, which
provides education, prevention, treatment, support and community engagement.
Continue to implement the 2016-17 Budget measure Taking More Action to Prevent Fetal
Alcohol Spectrum Disorders through delivery of projects to raise awareness, improve
diagnosis, and support families and individuals impacted by Fetal Alcohol Spectrum
Disorders.
Coordinate Australia’s engagement on international illicit drug issues, including our
obligations under various international drug treaties
93

The Australian Government aims to strengthen primary care by focusing funding to frontline
health services and improving the access, delivery, quality and coordination of primary health
care services. This will help improve health outcomes for patients, focusing on those who
are most in need, including those with chronic conditions or mental illness. It will also assist
in reducing unnecessary visits or admissions to hospitals.
In the 2017-18 Budget, the Government will provide $145.5 million to enable Primary Health
Networks to continue their central role in ensuring their local communities can access afterhours
primary health services.
In addition, the Government will spend $8.3 million over three years to boost funding for
palliative care coordination through Primary Health Networks to support people who have a
known life-limiting condition by improving choice and quality of care and support.
Working closely with GPs and other health professionals, the Government is progressing the
implementation of the Health Care Homes trial with 20 practices to commence
1 October 2017 and the remaining 180 to commence 1 December 2017.
94

A. Strengthening primary health care through improved quality and coordination
Support Primary Health Networks to increase the efficiency and effectiveness of medical
services for patients, particularly those at risk of poor health outcomes, and improve care
coordination and integration.
Support measures that improve the coordination and integration of services for people
living with chronic and complex conditions to help maintain good health, such as Health
Care Homes.
Support the delivery of health information, advice and services through interactive
communication technology to better assist people in caring for themselves and their
families.
95

The Australian Government provides incentive payments to general practices and general
practitioners through the Practice Incentives Program (PIP) to support activities that
encourage continuing improvements, increase quality of care, enhance capacity and
improve
access and health outcomes for patients
A. Supporting quality care, enhanced capacity and improved access through general
practice incentives
Provide general practice incentive payments through the PIP, including the PIP After
Hours Incentive, the PIP eHealth Incentive, the Rural Loading Incentive, and the
Teaching Payment.
96

The Australian Government aims to improve access to, and the efficiency of, public hospitals
through the provision of funding to States and Territories.
The Government will deliver an additional $2.8 billion to public hospitals in this Budget. Since
the signing of the Council of Australian Governments Heads of Agreement in 2016, the
Commonwealth has provided an extra $7.7 billion to support States and Territories to deliver
public hospital services.
The Government will provide $730.4 million upfront to transfer ownership of the Mersey
Community Hospital back to the Tasmanian Government on 1 July 2017 and secure the
funding for 10 years. This will provide certainty to the providers and consumers of
Tasmania’s acute care services.
In addition, the Government will also provide $6.2 million to the Tasmanian Government to
support the continued operation of the Missiondale Recovery Centre and palliative care
services in Tasmania.
A. Supporting the States and Territories to deliver efficient public hospital services
Support the Government through the provision of timely and effective policy advice on
public hospital funding matters.
97

Ottawa Charter for Health Promotion
98

Cultural Diversity of Australia
The cultural and linguistic diversity of Australia's population has been shaped by historical
events and policies both in Australia and other parts of the world . In particular, successive
waves of migration since World War II have contributed to the make-up of the overseas-
born population in Australia in 2011 . Initially most of these migrants were born in countries
in North-West Europe such the United Kingdom and Germany, and were then followed by
large numbers of migrants born in Southern and Eastern Europe, including Italy, Greece and
Yugoslavia. In the 1970s, many migrants arrived in Australia from South-East Asian
countries, including Vietnam, the Philippines and Cambodia, and more recently, from North-
East and Southern Asian countries such as China and India.
In 2011, around one-quarter (25%) of the Australian population were born overseas, while
around one-fifth (18%) spoke a language other than English at home. Of people born
overseas, one-fifth (21%) were born in the United Kingdom, 9% were born in New Zealand, 6%
in China and India each, and 4% in Italy. Amongst people who spoke a language other than
English at home, 9% spoke Mandarin, followed by people who spoke Italian (8%), Arabic or
Cantonese (both 7%), or Greek (6%).
99

Cultural Diversity of Australia
When country of birth and language spoken at home are considered together, 64% of the
population were born in Australia and spoke English at home, 5% were born in Australia and
spoke a language other than English at home, 11% were born overseas and spoke English at
home, and 13% were born overseas and spoke a language other than English at home.
Across Australia, the age structures of groups of people from different cultural and
linguistic backgrounds differ. For example, in 2011, people born in Australia who spoke a
language other than English at home were considerably younger (a median age of 18 years)
than people born in Australia who spoke English at home (35 years). People born overseas
who spoke a language other than English at home had a median age of 41 years, while
people born overseas who spoke English at home had the highest median age, of 49 years.
100

A Needs assessment is:
A systematic method of identifying unmet health and healthcare needs of a population and making changes to
meet these unmet needs. It involves an epidemiological and qualitative approach to determining priorities which
incorporates clinical and cost effectiveness and patients' perspectives.
This approach must balance clinical, ethical, and economic considerations of need—that is, what should be done,
what can be done, and what can be afforded.
102

Health status and behavior
Health status
deaths (mortality rates and life expectancy measures)
health conditions (prevalence of disease, disorder, injury or trauma or other health‐
related states)
human functions (alterations to body structure or function [impairment], activity
limitations and restrictions on participation)
wellbeing (measures of physical, mental and social wellbeing of individuals).
Health behaviors
attitudes, beliefs, knowledge and behaviors such as patterns of eating, physical
activity, smoking and alcohol consumption, and participation in cancer screening
programmes .
104

Workforce mapping
Number and distribution by type, such as GPs, allied health, pharmacy, specialist
services such as psychiatry, community health services etc.;
characteristics such as full or part time, public versus private, qualified but not
working in health care etc.
relationships between professional groups
Average access to GP score, by remoteness, 2011
105

Service mapping
location – including but not limited to physical location, hours of opening, with
consideration of identifiable gaps. For rural areas this would also include outreach
services, for urban areas it may involve some consideration of services outside the
PHN borders but accessed by people from within the PHN
utilization – including MBS and PBS data, a range of hospital data, such as use of
Emergency Departments and Potentially Preventable Hospitalizations, other
measures of occasion of service, and with a consideration of under‐utilization,
duplication and waste
Accessibility – including financial and cultural barriers and access to specialists and
secondary referred services, access to services after hours
responsiveness – such as wait times;
capability – such as skills and competence;
acceptability – such as cultural sensitivity, patient experience of and satisfaction
with the quality of care
quality – such as practice accreditation and PIP enrolment.
107

The Indigenous and non-Indigenous populations display markedly different distributions of
predicted need for health care by remoteness . On average, the predicted needs of the
Indigenous population increase with remoteness, but the predicted needs of the non-
Indigenous population are similar in Major cities, Inner regional and Outer regional areas
and then fall in Remote and Very remote areas.
109

Table shows that Indigenous people tend to experience a general pattern of worsening access to GPs
relative to need with increasing remoteness. This is due to the combined effects of worsening access
to GPs and increasing predicted need for primary health care.
Non-Indigenous people tend to experience a less dramatic decrease in access to GPs relative to need
with increasing remoteness. Average access to GPs does worsen with increasing remoteness, but
non-Indigenous people in Very remote areas tend to live in areas with higher access to GPs than
Indigenous people and have relatively low average predicted needs.
110

THE POORER HEALTH STATUS OF RURAL RESIDENTS/KEY FEATURES THAT DISTINGUISH RURAL &
URBAN HEALTH ?
Death rates in rural centers and remote areas are higher, especially Indigenous
Australians.
Rural Australians suffer a disproportionate number of work related deaths and injuries.
Suicide rates are higher in small rural and remote communities.
Dental health is also inferior to that of other Australians.
Respiratory problems, allergies and skin cancers are much higher in rural areas than
regional areas due to use of herbicides and pesticides, and outside work.
Road trauma, mental illness, alcohol and substance abuse are more prevalent in rural and
remote areas.
Smoking rates and alcohol consumption is significantly higher
111

DIFFERENCES IN HEALTH SERVICE USAGE
Lower access rates to GP’s and specialists, Medicare and pharmacy services
Higher levels of public hospital overnight stays
Poorer access to and choice of health care services
112

Community Profile & Socio Economic Disadvantage
Many residents with low incomes and low educational achievement.
Affects both ability to and likelihood of having health promotion focus
Can reduce likelihood of accessing appropriate health treatments
Having sustainable (and healthy) communities is dependent on an optimal configuration of
social and economic conditions: employment, education, taxation, infrastructure, housing,
environment, transport, etc.
 As we now know this impacts on health status and health outcomes (SDH)
Proportion of elderly residents often proportionately greater than in urban areas thus more
chronic disease management can be necessary
113

b). Geographical access / Health Service Access / Quality & Timeliness of Care Available
Location of and access to health services, transport
Difficulty accessing specialist services such as specialists, female GP’s, etc.
Health Professional (HP): difficulties with workforce training, recruitment and retention
114

c). Configuration of health conditions to be managed in rural areas differ
Elevated risk factors associated with lifestyles: higher rates of use of alcohol, tobacco and
other drugs
Greater exposure to injury risks
Combined, these things create need for residents and health workers to manage high
proportion of severe injuries and also chronic disease
115

Fetal alcohol spectrum disorders in Indigenous communities
Alcohol can readily pass through the placenta and enter the blood stream of the fetus,
where it can adversely affect its development. FASD is an umbrella term for the range of
physical, cognitive, behavioral and neurodevelopmental disabilities that result from
exposure of the fetus to alcohol. FASD can include: abnormalities in the formation of the
face, intellectual and learning disabilities, deficits in executive functioning, memory
problems, speech and language delays, inattention, hyperactivity, internalizing and
externalizing behavioral problems, and social impairments .
The range and severity of FASD symptoms differ from one person to the next, and the
symptoms remain apparent to varying degrees throughout life. Intellectual impairment is
commonly associated with FASD, but some children with FASD have average or even above-
average intelligence .
Although babies who are more severely affected could be diagnosed in infancy, it is also
common for developmental and learning delays and behavioral problems to be referred
and diagnosed only once children are at school. Delays in diagnosis can mean that crucial
opportunities for actions that might reduce the effects of FASD can be lost.
117

Fetal alcohol spectrum disorders (FASD) is an umbrella term for the range of physical, cognitive,
behavioral and neurodevelopmental abnormalities that result from the exposure of a fetus to maternal
alcohol consumption during pregnancy.
• FASD is entirely preventable if alcohol is not consumed during pregnancy.
• The range and severity of FASD-related conditions differ from one person to the next, and the
symptoms are apparent to varying degrees throughout life. This makes diagnosis difficult—
symptoms can manifest in a variety of ways, and it might not be apparent that a person has FASD.
• Fetal alcohol syndrome (FAS), which represents the severe end of spectrum, is more amenable to
diagnosis
because it is based on the following specific criteria:
– growth retardation
– characteristic facial features (small eye slits, thin upper lip and diminished groove between nose and
upper lip)
– central nervous system anomalies (including abnormal structure and function, such as
intellectual impairment).
118

The primary conditions common to FASD last a lifetime and may include the following which
vary from person to person:
• learning difficulties
• impulsiveness
• difficulty relating actions to consequences
• social relationships
• attention/hyperactivity
• memory
• developmental delays
• major organ damage
119

Failure to meet expectations and the development of defensive behaviors leads to an
increased risk of tertiary conditions.
These tertiary conditions can include:
• incomplete education
• involvement in the criminal justice system
• family and economic dependence
• poverty and homelessness
• alcohol and other substance abuse
• sexual victimization
• unplanned and early parenthood
• difficulty parenting and subsequent risk for children.
120

There is evidence from United States and Canadian studies that the following programs can alleviate
some of the effects of FASD:
– The parenting program Families Moving Forward assisted families and reduced behavioral
problem among children aged 3–13 with FASD.
– Children’s Friendship Training, neurocognitive habilitation therapy, and sustained attention
training improved the skills of primary-school-aged children with FASD.
– Stimulants and antipsychotic medications were effective in reducing hyperactivity among
children with FASD.
122

The following strategies have been shown to reduce alcohol-related harm in Australian Indigenous
communities. These strategies have the potential to reduce FASD rates by decreasing overall drinking
levels, including the number of women drinking alcohol during pregnancy, and how much they drink:
– supply-reduction strategies such as increasing the price of alcohol, restricting trading hours,
decreasing the number of outlets selling alcohol, dry community declarations, and culturally
sensitive enforcement of existing laws
– demand-reduction strategies such as early intervention, providing alternative activities to
drinking alcohol, and providing treatment and ongoing care to reduce relapse rates
– harm-reduction strategies such as community patrols and sobering-up shelters.
123

What are the key features that distinguish rural from urban health?
· Geography - Poorer access to health services due to vast distances between rural communities
and major regional centers.
· Determinants of health - Poorer access to some determinants of health such as:
o Sound education
o Appropriate housing and transport
o Safe, fulfilling and consistent employment
o Goods and services
o Fresh food
o Conditions that enable self determination.
· The Health system – Different services are available depending of level of remoteness
· Workforce and funding – often financial incentives are offered to recruit and retain workers.
· Health policy -depending of government will determine what financial and human resources
will be allocated to areas. Policy also affects definitions and classification of how remote an
area is therefore affecting funding for an area.
124

WHY IS RURAL HEALTH WORSE
-Greater risk of injury
-Socio-economic disadvantage
-Less access of health
-Fewer health providers
-Geographic isolation
Need for more education to rural and remote health professionals on specific health
promotion issues; in particular, alcohol consumption, chronic disease risk factors
especially relating to dietary advice and the need to refer to other health professionals,
and mental health.
The most effective approaches are multi‐sectoral eg , by linking health services, industry
(e.g. farming) and communities (e.g. schools, farming communities and families) to effect
health changes in targeted population groups.
Outreach services are effective and important ways to access rural and remote
communities, particularly Aboriginal communities.
Bringing mobile screening services to communities increases the identification of, and
referrals for, conditions that would otherwise be missed (e.g. mobile diabetes screening ,
community pharmacy‐ based screening , and hearing and vision screening ).
125

School based adolescent mental health program
– reduced self harm, early detection, enhanced wellbeing.
Hub and spoke training model to train rural health and education staff to identify eating
disorders.
Farm family gathering – social/farm management gatherings organised by the Department
of Agriculture, NSW, and attended by many service providers (including mental health
services) and government and non‐government agencies.
Care needs to be flexible, and contextually relevant for the community, Potential for
innovative, networked models of care focused on the needs of the patients
126

Describe the challenges of rural and remote health
There are vast and diverse challenges associated with the actual geography of rural remote health.
Infrastructure in some area’s of Australia limit particular services to physically reaching some priority
populations.
There are also diverse cultural and sociological needs in regards to health.
Service delivery to rural remote areas generally require more funding due to lack of infrastructure and
the nature of these areas.(eg: may be considered harsh environment, dry arid conditions that are not
appealing for a majority of workers to live in). Financial incentives are offered to recruit and retain the
rural health workforce. In summary, the main challenges include:
· Greater risk of injury
· Less access to health services
· Geographic isolation, poor quality roads
· Socio economic disadvantage
· Fewer health providers
The biggest challenge is improving equality of access to health services and reducing health inequities.
127

Challenges of rural and remote health ?
-Funding and delivery of health care
-Problems with health workforce supply and distribution, lower availability of serives
-Persistent concerns about the quality and safety of health services
-The growing burden of chronic disease in rural and remote Australia
-Place-based approaches to meet local community health needs
-Increase in mental health problems and suicides under young Australians
-Attaining equal health
-Lower incomes, lower levels of education and employment and poorer access to health services
-Higher risk areas of poor health, higher rates of smoking, greater rates of disability and lower
rates of physical activity.
-Poorer health-related infrastructure
-Poorer housing/accommodation
-Less secure and costlier access to fresh food and water
-Greater inherently dangerous occupations
-Poor health habits./choices (tobacco smoking, alcohol, drugs)
-Higher cost of food in remote areas, less variety and less quality
-Lower education attained by an individual, important determinant of workforce status/income
-Limited employment opportunities
128

What Strategies could address health inequalities faced by people living in rural/remote
communities?
Inequality and inequity both refer to disparities between groups or individuals.
Inequality refers to the uneven distribution of health outcomes that can be attributed to biological
variations (eg; a medical condition that is inherited) or pre-determined factors (eg age)
Inequity refers to an avoidable difference.
Strategies to minimize the avoidable health outcomes in rural remote communities will reduce the
disparities between rural health and urban health. These
strategies are developed arounds the concept of access to services using the following dimensions;
· Approachability – identifying that a service exists
· Acceptability – social and cultural factors influence preference for a service
· Availability and accommodation – geographical location
· Affordability – financial and time costs related to using the service
· Appropriateness – clients health care needs and care spent trying to provide correct treatment
and care.
129

Strategies include;
· Financial assistance is often provided for rural residents to access health care.
· Workforce initiatives – improve training, recruit and retain health service staff
· Outreach services such as fly-in, fly-out women’s health practitioners (outreach services)
· ACCHO – (Aboriginal Community Controlled Health Organizations)
· GP based hospitals
· Transitioning to primary health care (PHC) services – patient centered care
· Information and technology – improve use and availability of technology for training,
information, management, and delivery of health services.
130

Strategies could address health inequalities faced by people living in remote/rural areas ?
-Identifying the key priority issues people faces in rural and remote areas
-Recognize the needs of people living in rural and remote areas
-Assess the needs and assets of people living in rural and remote areas
-Health planning and Health programs to improve access to health care for people living in
remote/rural areas
-Community health programs what provides relevant health care and support services
-Remote General Practice Program to increase the number of Gp's working in rural/remote areas
providing more opportunities to train medical students and doctors in rural areas
-Improve the delivery of health services, health care and increase health care services
-School education program to make children learn and create awareness of health from a young
age
131

Is there a link between the history of colonization in Australia and contemporary health
outcomes for Indigenous Australians?
Australia was colonized on the basis that the land was terra nullius (or considered vacant)
because Aboriginals were considered to not be making use of the land. They were
considered barbaric and dangerous. As a result, Aboriginal people were exposed to great
trauma and rapid lifestyle changes.
Further understanding of Aboriginal culture proves how detrimental colonization was to
Aboriginal people and consequently their social, physical, emotional and mental well-
being.
In Aboriginal Culture, health is viewed as a collective. It is inseparable from, and embedded
within family and community. Social and emotional well-being is closely connected to
country, spirit, family and community. When these connections are broken, so to are the
social, emotional and mental well-being.
The social justice complexities that followed colonization (eg: stolen generation,
massacres) made Aboriginal culture vulnerable and in many cases, identity, language,
traditions and family was lost. The impacts of this follow into modern social complexities
and consequently affect contemporary health outcomes.
134

Impacts from colonization include:
· Invasion
· Dispossession (land and children)
· Government policies
· Disconnection from land/country
· Total dependency
· Stolen generation
· Devastating disruption to and disconnection from community and family structures
· Loss of traditional diet and use of traditional land for hunting, gathering, farming, fishing
· Loss of culture and language
· Racism
· Epidemic levels of chronic disease, injury, incarceration, removal of children (child services)
· Unsuitable housing and overcrowding
135

Colonization of Australia impact on aboriginals health
-Unemployment, poverty, poor education
-Alcohol and substance abuse
-Domestic violence, accidents, deaths in custody
-Poor Nutrition
-Low birth rate, diabetes mellitus, hypertension, cardiovascular disease
-Poor housing, poor hygiene, overcrowding and infectious disease
-Respiratory disease, ear disease, rheumatic health disease, renal disease.
137

How do the social determinants of health influence the health of Aboriginal and Torres
Strait Islanders and their access and utilization of health services?
The higher the number of social determinants an individual is exposed to, the higher the
gradient is to achieve optimal health outcomes. The more adverse exposure to social
determinants an individual has, the greater the impact it has on people’s ability to manage
their own health. a coping mechanism (but note a significant social determinant of health).
Accessibility to health care is influenced by economic and geographical factors and a
variety of sociocultural factors. It is therefore important to increase efforts to improve the
ability of all systems, services and practitioners to work with the diversity of patients
The inter-relationship between health and social determinants such as education,
employment, social gradient are closely observed. For example, the Longitudinal study of
Indigenous children has found 83 per cent of Indigenous children with better health
attended school at least 80% of the time compared with 65% of the time for children with
poorer health. Similarly, poor health adversely affects employment which in turn affects the
social gradient.
138

How do the social determinants of health influence the health of Aboriginal and Torres
Strait Islanders and their access and utilization of health services?
The disparities that exist between Indigenous Australians and non-Indigenous Australians
exist for
Geographic reasons - a large population of Indigenous Australian live in rural or remote
areas where access to services is limited due to the demography, limitations in
infrastructure and the distance of travel and transport options.
Cultural – the concept of health services may differ. An understanding of cultural diversity,
rights, views, values and expectations need to be delivered appropriately.
Social – Determinants such as education, employment, social gradient all affect health and
access to health, whether it be education limitations (not having sound reading or writing
communication skills) may influence the individuals willingness to seek help or
understanding how to navigate the health system. Cost of health care may also be another
social determinant that is linked to employment and the social gradient. If an individual is
unable to afford treatment or prevention, they are less likely to access medical help until it
has progressed to a serious secondary or chronic condition.
139

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