Application in Australian Health System - Essay Example

? Professional Mobility Table of Contents Introduction……………………………………………………………………………..3 Organizational theory……………………………………………………………………3 Design theory……………………………………………………………………………4 Systems theory………………………………………………………………………......4 Positive and negative attributes…………………………………………………………5 Application in Australian Health System……………………………………………….8 Recommendations………………………………………………………………………10 Conclusion………………………………………………………………………………11 References………………………………………………………………………………13 Professional Mobility Introduction Health care reforms focus on rationalizing cost, improving quality, and enhancing access to healthcare. These reforms require and stimulate radical and fundamental changes in the structure of the healthcare system. Healthcare relies on rapid development of knowledge and information, rapid transfer of the knowledge, importance of the service to the economic life, and the development of new organizational forms and concepts. Health professional mobility changes the health workforce in both the sending and receiving countries. The gains and losses strengthen and weaken the overall performance of the health systems. Skills and knowledge required for health reforms travel with the mobile health professionals. Outflows of these professions can impact the health system performance when the skills involved are rare and essential. Professional mobility also affects the distribution of health workers in a country or region. Globalization of the health workforce is a major factor in the global development of the knowledge economy (Palmer and Ho, 2008). Organizational theory Healthcare enterprises are participating in organizational changes and experimentation. Developing new organizational structures is a major contemporary business life. An organization contains several specialists who coordinate and blend their skills in order to achieve a common purpose. The organization contains relationships that are persistent over time and the administration must anticipate the future so that the relationships remain persistent (Griffith 2000). Division of labor in an organization plays a major role in reducing cost, increasing productivity, and maximizing profits. This division creates a hierarchy of authority that creates a line of communication and control. A functional organization contains specialization of tasks that define the hierarchy of authority. Relationships between employees and treatment by managers also affect the performance levels. These relationships determine the social factors driving human behavior in an organization. The current revolution of the business environment requires organizations to cope with continuous change, set a skill level for workers, customize products, and dominate the service industry. Design Theory Innovations and systems in the health care are characterized by complex and unclear boundaries that involve the elements of innovation and organizational structure. The readiness of the organization determines whether the design will be accepted or rejected. Therefore, the change depends on the resource system, knowledge of purveyors, change agency, and user system. The user system is linked to the resource system and change agency during the design and implementation stages. The environment must be designed to integrate these components so that it can have maximum economic value. Innovations are evaluated by randomized or quasi trials to determine their viability. The trials lead to the classification of innovations as wither simple or complex. Health care institutions look for performance of the innovations during trials as prove of their viability and operable design. Experimental designs are clearly inadequate, and health institutions have to employ realistic evaluation of designs (Keller, Gare, Edenius, Lindblad, 2010). Systems theory Health care systems are categorized depending on the level of care provided within the system. Types of care within a system include acute care, home care, extended care, and ambulatory care. Patients move from one level of care to another within the system. A system is a set of objects that interact in order to achieve a certain goal. The systems have common elements and process energy, information, or materials into a product (Chuang and Inder, 2009). The health care system consists of three interlinked systems namely accreditation system, quality measurement system, and the organizational system. The functionality of these systems determines the environmental reaction of the output of the organization. When patients are satisfied with the quality of services, they are likely to return; thereby increasing the inputs. Human resources are needed in the system to produce the products. Health professionals and administrators are required to provide services to patients. Positive and Negative Attributes Organizational theory introduces specialization in the healthcare organization. Each area is separated into a department headed by a supervisor with extensive experience in that area of specialty. Specialization introduces centralization of functions and directives originate from a centralized position and are communicated to supervisors of every sub-department (Wallace et al, 2001). In healthcare, this theory introduces two reporting lines: program manager and discipline chief. Specialization introduces strong levels of expertise in the organization. Physicians and other workers are distributed to various departments where they perform duties based on their levels of expertise. This eliminates inefficiency and time wastage that exists when a health professional is responsible for several duties. It is possible to restructure or re-engineer the business process to improve the quality of service, speed, and reduce the cost. The theory also supports learning by incorporating personal mastery, shared vision, systems thinking, and mental models. Physicians in every department can expand their knowledge and skills by engaging in training sessions. However, the theory introduces bureaucracy in the organization. Nurses and junior workers have to wait for instructions from managers. The organization has a predefined command system, which determines decision making. Centralization causes inefficiency when the manager is incapable of making sound decisions. This makes the health care organization less responsive to changes in the departments. As the categories of subordinates reporting to one supervisor increase, it becomes difficult to monitor individual performance. This decreases the efficiency of nurses and other health workers in the organization. Departments may require similar resources, which leads to duplication of resources. The departments run concurrent activities that use similar resources (Parker, Charns and Young, 2001). The design theory introduces a mechanism and reviewing innovations to determine their viability. The model outlines standards that must be met before an intervention is declared simple or complex. The design takes into account the abilities of the users of the intervention (Denis et al, 2002). The designer makes mechanisms that meet the qualifications and abilities of the target audience. The knowledge of health professions is used to evaluate treatment outcomes after utilizing a certain mechanism. Design theory creates room for quality improvement. The intervention includes measures that can improve the performance or quality of results produced. The intervention targets certain change agents in an organization, and the designer customizes the innovation to meet the qualifications of these change agents. The theory helps designers understand mechanisms that lead to desired outcomes. The steps required to produce the desired outcome can be determined by applying the theory in the design process. Realistic evaluation proposed in the theory does not determine whether the intervention works or not, but provides the outcome patterns. The professional has to interpret the outcomes and determine whether the product will work. Some products or innovations have complex structures that require modifications of the theory (Gregor and Jones, 2007). The current functional areas in the theory are not conclusive when applied in complex interventions. The design requires methods of dissemination that are not stated in the theory. This forces professionals to device their own methods of dissemination that may vary from the original theory. System readiness determines the type of intervention to implement in a given health care organization. The outer context of the design theory requires norm-setting and incentives that create environmental stability. The systems theory incorporates concepts of emergence and hierarchy and control and communication. This helps health professionals model complex systems that can be expressed in terms of hierarchy levels in the organization (Pomey, 2004). The systems incorporate safety of patients and quality of health care when developing health systems. The health system contains a feedback loop that provides information that keeps the system in dynamic equilibrium. Control creates the need for communication to create stability of the system. This ensures that safety and quality of service are maintained by professionals working under the system. The division of the health system into sub-systems enhances administration capacities that improve the quality of care. Changes are eminent in a system, and the managers must manage them in order to minimize negative output to the environment. The theory can be applied to health sectors in different environments such as third world countries and developed countries. On the other hand, every system contains different rules used in decision making leading to varying outcomes. Functional systems require active feedback that balances the internal and external factors. Negative feedback causes imbalance that creates a mismatch of the factors controlling the system. Imbalances in the feedback loop offset the system stability, which leads to unpredictable results (Chuang and Inder, 2009). The system has several uncertainties that have broad implications in the organization. Unexpected outcomes may increase the cost of business or lead to poor services that affect the patient’s health. Systems are usually complex and depend on other related systems for stability. Changes in one system may lead to unexpected changes in the other. Systems are affected when core elements are separate, which leads to deficiencies. These deficiencies cause imbalances in the system that affects the stability and output to the environment. Application in Australian Health System According to ADHA (2005) the ratio of full-time equivalent doctors to patients is 0.71:1000. This indicates a shortage especially in the rural, remote, and outer metropolitan areas. Health professional mobility changes the composition of the workforce, which impacts the health system performance (Zurn, P, et al. 2004). The health profession mobility interacts with other factors and challenges that affect the workforce. These factors include new technologies, globalization, working conditions, environments and training capacities. The aging population, growing community expectations and the demand for health workforce have increased the expenditure on health care. The number of elderly people, 65 years and over, in 2002 was 12.7%, and it is estimated to reach 27.1% in 2051. The health expenditure was 9% of GDP as of 2009. This translates to $5,190 per person, which totals to about $112.8 billion. Australia is a favorite destination for migrating health professionals. Several Australians have long life-expectancy and the country has a high international ranking in terms of health status. About 7 percent of nurses in Australia have migrated from England and 2 percent from New Zealand (Birrell, 2004). Nurses migrating from other countries have a high likelihood of working in cities. However, majority doctors migrating into the country work in remote and rural areas. These migrations can undermine the attempts to forecast workforce needs. Inflows and outflows have to be understood and considered in the planning according to the organizational theory. Planners have to understand the trends and warnings of their fluctuations to reduce uncertainty. Organizational theory promotes specializations and planners have to consider the skills of the incoming and outgoing health professional. Effective strategies are required in order to change the skill-mix and tax distribution in order to encourage specialization (Dowton, 2005). The working environment requires improvement as a strategy of retaining health professionals. Some immigrant professionals leave the country after some years. Some of the Australian health professionals leave the country and seek jobs in other countries. The work environment must be designed to fit the current workforce in the Australian healthcare (Duckett, 2005). The free movement of health workers is an economic imperative aiming at promoting access to cheap health care. All Australians require equal access to health care, which depends on the availability of health professionals. Designing the health care system should involve allocating the scarce resources to all people. The workforce and health subsidiaries are scarce and encouraging free movement of professionals will ensure the availability of scarce health workers. The health expenditure in 2000 was $3,153 per person due to scarcity of affordable health care. The massive migration of health professionals into the country has increased the life expectancy by 10 years and decreased death from external causes from 72-41 (Duckett, 2004). The mobility of services may threaten the economic viability of hospitals by increasing difficulties in human resource planning. The government and health organizations have to accommodate the influx of health workers when designing their programs and organizing their structures. Excess health care professionals in the country complicate the planning process. This threatens patient safety and quality of service due to poor planning. The number of general professions providing more than 10 sessions per week has reduced drastically. A survey by AMWAC identified that about 28 percent of the doctors worked excess workers and considered switching to part-time practice. This increases the difficulties in providing a sustainable and continuous healthcare (Halcomb et al, 2005). Recommendations There are about 450,000 paid health professionals of whom 350,000 are employed in the health service industry. Nurses comprise over 50 percent of health professionals and medical professionals are about 12 professionals. The government heavily influences the supply of these workers and the type of services provided. The government should enact laws that maximize the employment of health professionals to meet the rising demand (Keleher, 2007). The government is the major employer of health professionals and contributes two-thirds of the health care expenditure. Increasing the number of health professionals employed by the government would eliminate the current deficiency and help reduce the expenses. A significant of health professionals do not work in the sector. The government has suppressed Australian health professionals, which has reduced the number of local professionals in the health sector. The government can provide preference of local professionals instead of relying on foreign professionals. A balance is required between all sectors and regions requiring professional healthcare. The rural areas, metropolitan areas, aged care, disability services and mental health have few professionals (Murray and Wronski, 2006). Registration of health professions allows the government to track and monitor health professionals. The registration process has to be streamlined to reduce under utilization of skills of some health professions. Registration and periodic fees are required for initial registration and maintaining the registration. The government should lower the registration fees so that the number of registered health professionals can increase (Hawthorne, Hawthorne and Crotty, 2006). Some health professionals leave their country, remain in Australia or return after a number of years abroad. Policy makers seeking to develop recruitment and retention policies must understand the motivation factors governing professional mobility. This will reduce the negative impacts associated with professional mobility. Ageing has contributed to the current shortage of health professionals. The number of old professionals over the age of 55 years has increased considerably over the past decade (Jackson, 2008). The government should concentrate on young professionals especially graduates to increase the number of young practitioners. Over 74 percent of the health workforce is women especially in the nursing profession. This is because over 60 percent of medical students in Australian medical schools. Key players in the health sector should create a balance of gender in the health care profession. Conclusion Australia is a major destination for migrating health professions. This has increased the accessibility of quality health care, which has lowered the mortality rate and increased life expectancy. However, the country still experiences shortage of health professionals due to undersupply of local professionals and an ageing population. The government employs a large percentage of both local and foreign professionals and makes the largest contribution to health expenditure. The influx of health professionals complicates the organization of human resource in hospitals. The health department has to design an environment that accommodates all professionals into the health system. The largest number of migrant professionals is concentrated in cities. Rural and metropolitan areas still experience a shortage of health professionals. 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