It's time for big picture thinking

By Alison Verhoeven, Chief Executive, Australian Healthcare and Hospitals Association

Source: APNA Primary Times Spring 2020 (Volume 20, Issue 2)

Our nation’s experience in tackling the challenges of COVID-19, following on from the 2019-20 bushfires and other climate-related disasters, provides a catalyst for re-imagining healthcare.

Areas of healthcare characterised by inertia have been disrupted, with rapid developments in implementing telehealth, team-based care models, and cross-sector integrated care pathways that embed considerations of social care needs.

However, the gains made are at risk, with a return to typical healthcare practices, processes and professional interests likely if the sector does not come together and commit to new ways of doing business.

 

Telehealth and virtual healthcare stand out as opportunities which should continue to be leveraged in a post-pandemic world. Patients rightly expect that the positive benefits experienced with these models of care during COVID-19 will continue now and into the future. Patients are more open to using technology and see its importance in improving health outcomes.

In a recent briefing paper, South Australian GP Dr Chris Bollen and Deeble Institute Director Dr Rebecca Haddock provide case studies which demonstrate the opportunities to improve health outcomes and patient experience of care through use of telehealth consultations in general practice.¹

Six case studies demonstrate ‘at the coalface’ how telehealth can benefit general practice, maximise equity of access to healthcare, and support patients in developing their own health knowledge and skills.

The substitution of face-to-face consultations with phone calls, and to some extent videoconferencing, has been the main change observed during the COVID-19 pandemic. E-prescribing has offered some further functional improvements. The introduction of ‘virtual hospitals’, with remote patient monitoring, demonstrates further the opportunities that virtual healthcare models can bring to a system.

 

Primary health care nurses are a crucial part of the team, bringing expertise in care planning, coordination, monitoring, and health promotion. There are reports that some nurses have had their role continue to be supported and embedded to best meet patient needs with the changing models of care during this pandemic, yet also reports that others have had their role diminished as a direct result of the changed funding policies.

When looking to adopting virtual care arrangements, tasks and processes need to be redesigned around patient needs, not just provide a substitution of existing models. This includes team-base care models, for example, using telehealth and primary health care nurses to improve management of chronic disease, especially in older patients with multiple and complex chronic conditions.

Opportunities for artificial intelligence and other innovations will continue to grow, and should be used to create new models of care, such as that being trialled to introduce an app in the analysis and treatment of wounds in a nurse-led model of care.

 

"Data must be used to drive quality improvement and create new models of care."

 

Importantly, it will require more than policy-making on the run, such as the recent ‘stage 7’ telehealth decision by the Australian Government where telehealth GP providers need to have an existing and continuous relationship with a patient—defined as seeing that patient in the last 12 months—in order to provide MBS-funded telehealth services.

While this may stop the ‘pop-up’ online services opposed by doctor organisations, and limit opportunities for over-servicing, it will also be a huge barrier for rural communities where access to any GP can be a problem, for healthy people who infrequently see their GP, people whose local practice is booked out for weeks, those requiring sexual and reproductive health services, and people who want to change doctors.

It also ignores the continuous relationship a patient may have within a team of providers, including primary healthcare nurses. Providers must also recognise that for personal reasons, people may prefer to seek care away from their regular practice for some very sensitive matters.

 

Sustained and coordinated policy efforts are needed. Another AHHA report discusses the priority areas such as funding, governance and workforce necessary for embedding sustainable long-term virtual health care models.² At AHHA we think key areas of focus to maximise the long-term benefits of virtual health care include:

•       Patient-centredness, including codesign with patients, and measuring what matters to patients;

•       Equity, including proactive efforts to ensure affordability, equitable access to technology and digital literacy;

•       Cross-sector leadership and governance, across jurisdictions and the primary and acute care sectors, and in partnership with industry and researchers;

•       Digitally-capable health workforce development, prioritising team-based care and new roles needed to optimise integration of technology into health care;

•       Interoperability, standards and quality assured technology; and

•       Funding for reforms, including better use of data and evaluation.

 

Enabling team-based care will be another important strategy, not only to provide wrap-around services for individual patients, but to build capacity for regions and communities through workforce models that address population needs.

Team culture and trust must be fostered, the workforce must be enabled to work to the top of their scope and less hierarchical structures must be supported as members work collaboratively towards shared goals.

Governance frameworks recognising distributed leadership can provide practical structures for composing teams and the way they collaborate.

The provision of care through team-based and virtual care models that deliver better outcomes and experiences may be occurring in Australia, but they are occurring despite of, rather than because of the system in which we are operating.

 

Now—more than ever—as we face the most significant health and economic challenges experienced in a century, we need big-picture thinking and serious policy reform efforts that are agile and innovative.

We cannot shy away from disruptive thinking and the need to do business differently in order to achieve better results that take full advantage of the modern technologies and the breadth of professional expertise available to us.

 

REFERENCES

1.      Providing telehealth in general practice during Covid-19 and beyond, Perspectives Brief Number 10, authors Dr Chris Bollen and Dr Rebecca Haddock, published by Deeble Institute for Health Policy Research and the Australian Healthcare and Hospitals Association, July 2020

2.      The effective and sustainable adoption of virtual health care, Australian Healthcare and Hospitals Association, July 2020