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Queensland Health skills development centre

Country: 
Australia
Partner Institute: 
Centre for Health, Economics Research and Evaluation (CHERE), University of Technology, Sydney
Survey no: 
(4)2004
Author(s): 
Marion Haas
Health Policy Issues: 
New Technology, Quality Improvement, HR Training/Capacities
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no no yes no no

Abstract

The QHSDC is a government sponsored centre which aims to assist in the development of a safer, flexible and effective health workforce. An important goal is to provide a springboard for the fermentation of ideas to enable the production of innovative and research-based courses whose outcomes are properly evaluated. It encompasses mock operating theatres, laboratories and virtual reality skills areas and aims to be self funding through providing educational courses to health care professionals.

Purpose of health policy or idea

The objective of the Queensland Health Skills Development Centre (QHSDC) is to assist in the development of a safer, more flexible and effective workforce to meet the challenges of working in the 21st century. This will be achieved by:

  • linking curriculum to strategic need
  • collaborating with industry and other skills centres
  • applying sound business and management principles
  • applying innovative techniques and tools, particularly in the spheres of patient safety and human factors.

The centre is the first State sponsored facility of its type in the region and is intended to be a useful resource for the whole State. It is focused on skills development and innovation in the areas of surgery, anaesthetics, communications, human factors, patient safety and health imporvement sciences.

Although the Qld government has allocated resources for the capital costs of setting up the centre, it is intended that the Centre will be self-funded from the profits made by delivering educational courses to Qld Health staff, and the health industry generally from other Australian states, New Zealand and SE Asia.

Main points

Main objectives

The objectives of the QSDC are to:

  •  provide training to assist in the development of a more adaptable and safe workforce
  • work within a Board approved financial plan to reach self-sustainability
  • enable good ideas to be translated into innovative and research-based courses whose outcomes are rigourously evaluated.

Type of incentives

The Qld government and Qld Health have incentives to fund the development of the QSDC which relate to attracting and retaining skilled staff to work in the State's health care facilities. The QHSDC's incentives involve working within the budget approved by its Board and meeting its ongoing financial obligations through attracting paying customers (ie students) for its courses.

Groups affected

Health care professionals in Qld, Health care professionals in other parts of Australasia and SE Asia, Users of health care services in Qld

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Characteristics of this policy

Degree of Innovation traditional rather innovative innovative
Degree of Controversy consensual rather consensual highly controversial
Structural or Systemic Impact marginal rather marginal fundamental
Public Visibility very low very low very high
Transferability strongly system-dependent system-neutral system-neutral

Whilst the use of simulation to train health care professionals seems a sensible idea, it has not been evaluated rigorously and not systematically assessed in relation to the alternatives. Such evaluations should be funded as an integral part of the work of centres such as the QHSDC.

As well as providing training and education, the QHSDC (and other Centres like it) should also be funded to evaluate:

  • the extent to which its educational products meet the standards required for best practice in education
  • the extent to which provider and patient outcomes are influenced by the provision of such training
  • if outcomes are enhanced, which aspects of the training process are the most relevant to achieving this.

Political and economic background

The QHSDC originated as a rapid learning concept in 2000 and was regarded by the State Department of Health as a useful resources for the entire state. It was thus made into a state-wide initiative. Although there are approximately 300 such centres in the world (7 in Oceania), the QHSDC claims to be the only State sponsored centre as others have grown organically around one or more individuals who have been passionate about simulation.

The centre also has responsibilty for hosting the Centre for International Medical Graduates which trains overseas-trained doctors to pass their Qld medical registration and for the Pre Hospital Trauma Life Support program, a training package that aims to improve the outcomes of patients involved in trauma in rural and remote areas of Australasia.

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no no yes no no

Origins of health policy idea

The idea is not new to Australia or Queensland as there are approximately 300 medical skills simulation centres in the world. The main purpose of such facilities is to simulate many of the medical and environmental conditions which arise in real patients and settings. As a result, practical training can be undertaken in an environment which is separate from but represents realistic clinical situations where emergency and/or adverse events can occur. Training in such situations is particularly valuable because it removes the pressure of time and stress from the teaching environment as well as reducing risks for patients.

Many such facilities have been set up as a result of the passion and drive of individuals who have convinced government and other funders to sponsor the development of the organisation over time. However, the QHSDC is the first in Australia to be wholly government sponsored and not to be affiliated with a particular hospital.

The Skills Development Centre has its own corporate governance structure with membership drawn from both the public and private sectors. Under the leadership of Acting State Executive Director of Innovation and Workforce Reform, Dr Mark Waters, it provides the strategic direction for the Centre and monitors the operations through three sub committees. The Centre has a small management team that brings the strategic vision into reality, including a chief executive officer,  project manager, multi media manager and simulator coordinator.

Initiators of idea/main actors

  • Government: Through the Department of Health, the Qld government is the main actor/stakeholder
  • Providers: Lead clinicians provide training within the centre
  • Scientific Community: Academics from the University of Qld provide support for the centre's activities, including evaluation of the effectiveness of the curricula developed by the Centre

Approach of idea

The approach of the idea is described as:
new:

Stakeholder positions

It is not clear that there has been any opposition to the centre. The support for the centre from leading academics and clinicians indicates that it is regarded as necessary for the development of clinical skills. However, no data are available about the total number of training courses offered or the number of attendees at such courses.

Although not explicitly stated, it is likely that providers and academics were the originators of the idea of the QHSDC which commenced as a rapid learning centre concept in 2000. However, the State government has been convinced to fund the capital equipment needed by the facility.

Actors and positions

Description of actors and their positions
Government
Queensland Healthvery supportivevery supportive strongly opposed
Providers
Lead cliniciansvery supportivevery supportive strongly opposed
Scientific Community
University of Qldvery supportivevery supportive strongly opposed

Influences in policy making and legislation

No information available

Actors and influence

Description of actors and their influence

Government
Queensland Healthvery strongvery strong none
Providers
Lead cliniciansvery strongvery strong none
Scientific Community
University of Qldvery strongstrong none
University of QldQueensland Health, Lead clinicians

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Adoption and implementation

The main actors in the adoption process were the Qld government and the providers and academics involved in the original concept. However, the Board of the centre is involved in providing ongoing direction to the management group who are charged with meeting the objectives of the centre through providing training and raising funds via educational courses to maintain its functions into the future. Therefore, they must promote the facilities and training available to both public and private interest groups to ensure sufficient uptake of the educational training to meet the financial needs of the centre.

Monitoring and evaluation

Monitoring: Although no specific mechanisms are listed, as one of the goals of the QHSDC is to produce innovative and research-based courses whose outcomes are properly evaluated, it may be expected that monitoring the extent to which this occurs will from part of the activities of the centre.

Evaluation: A number of lead clinicians have been commissioned to develop the Centre's curriculum. Associated with this, the Centre is collaborating with the University of Qld to evaluate the effectiveness of the products it develops. In addition, visiting faculty assist in the development and evaluation of curriculum. The Centre also uses external instructional designers on an as required basis.

Dimensions of evaluation

Outcome

Results of evaluation

Not available

Expected outcome

A limited amount of information is available regarding the ability of the QHSDC to meets its objectives. Whilst it may be able to provide educational services within its budget, as the demand for such services is unknown, it may also fail and need further financial support from the Qld government. Alternatively, should the government choose not to provide additional support, the Centre may be forced to seek support from private companies. Such companies are common supporters of these Centres around the world, including Australia. Their influence on the courses provided and the equipment or devices used and/or recommended will depend on the relationship between the company and the Centre which may range from allowing the Centre to retain its independence to some provision of company-related marketing material or a requirement to use and market its products or even prohibition of the use of competitors' equipment etc thus potentially errecting barriers to competition.

The scientific evidence regarding the effectiveness of simulation as a means of increasing the skills of health care professionals and/or the translation of these skills to practice is limited. No Australian evidence could be identified. Small-scale studies have shown that students, interns and residents can improve their skills in areas such as laparoscopic surgery and cardiac events (McGaghie and Issenberg, 2001). However, an assessment of the capability of virtual reality to train surgeons in laparoscopy was inconclusive (Johnson et al). Norman (2003) described computer based simulations as a "cottage industry championed by enthusiasts" and questioned the transferability of skills from the simulation laboratory to real patients, the use of single medium versus multi-media systems, the cost-effectiveness of simulations versus computer-based education and the lack of educational theory and best practice in relation to the use of simulators. The publication of this article was followed by a rebuttal of the main points raised by Norman although the authors agreed that there was a dearth of educational research in the health sciences (McGaghie, Issenberg and Petrusa, 2003).

Thus, the literature suggests that there is little evidence or agreement about the effectiveness of simulation as a means of improving the quality of care. No published evidenced was identifed regarding the effect of education using simulation on the costs, cost-effectiveness or equity of access to health care.

Impact of this policy

Quality of Health Care Services marginal rather marginal fundamental
Level of Equity system less equitable neutral system more equitable
Cost Efficiency very low low very high

As the model of training using simulation has not been well evaluated, it is not possible to rate the impact as being more than neutral or marginal. As there are many centres like the QHSDC in the world, it is to be expected that this may change in the near future. The First Oresund Symposium on Clinical Skills Training entitles "Why Skills Centres" will be held in Lund, Sweden in November 2004. Among its aims is "to discuss the impact of simulator training on clinical competence and the relation to quality of care and patient safety".

References

Sources of Information

http://www.health.qld.gov.au/skills

http://www.nsh.nsw.gov.au/services/smsc

William C McGaghie and S Barry Issenberg (2001). Acquisition and maintenance of medical expertise from deliberate practice using simulation technology. Interface. http://www.gasnet.or/interface/12.1.3mcgaghie.html

Rob Johnston, Sunil Bhoyrul, Lawrence Way, Richard Satava, Kevin McGoven, Dexter Fletcher, Shawn Rangel, R Bowen Loftin (date not available). Assessing a virtual relaity surgical skills simulator. http://www.vmasc.odu.edu/vetl/html/surgery/mmvr4b.html

Geoffery Norman (2003). Simulation - saviour or satan? Editorial. Advances in Health Sciences Education. 8:1-3.

William C McGaghie, S Barry Issenberg, Emil R Petrusa (2003). Editorial: Simulation - saviour or satan? A rebuttal. Advances in Health Sciences Education. 8: 97-103.

Author/s and/or contributors to this survey

Marion Haas

Suggested citation for this online article

Marion Haas. "Queensland Health skills development centre". Health Policy Monitor, October 2004. Available at http://www.hpm.org/survey/au/a4/5