As the future creeps closer to a new decade one thing is certain. Change is here to stay. In this new series about the changing nature of work Insight talks to leading academics to find out how workforces can evolve and keep pace. First, we’re taking a look at the healthcare sector.
Where is healthcare headed?
The coming decades will see the healthcare industry face unique challenges that will need innovative solutions to ensure patient care remains effective, equitable and economically viable.
We caught up with a number of healthcare professionals at Charles Sturt University (CSU) to explore the nature of these changes and how healthcare provision is responding to them.
Meeting the needs of a changing demographic
The demographic profile of Australia is changing like never before. Immigration is one factor, but arguably the biggest structural shift is the fact that Australia is, in terms of the people who live here, getting older. It is predicted that people aged 65 and over will comprise 22 per cent of the population by 2057.
Often this shift in demographics is presented pejoratively. You may read of a ‘time bomb’ or a ‘looming crisis’. Of course, an ageing population presents challenges socially, economically and in terms of healthcare provision, but it also presents opportunity.
Maree Bernoth, Associate Professor of Nursing at CSU, said that the changing demographic means unique possibilities for healthcare workers.
“The growing number of older people means that healthcare workers can work with people from preconception right through the lifespan, so that patients have quality of life throughout their lives. That’s exciting for healthcare workers. More people living longer is a sign of a successful society, but we want people to age so they don’t have co-morbidities and chronic health problems that some of our current older cohort of people have.
“And as we understand more about the ageing process and effects on it through research, frontline healthcare staff like nurses can help people apply this knowledge to ensure their quality of life, such as health promotion about lifestyle choices as we age.”
Lifestyle and prevention
Professor Megan Smith, Director of the Three Rivers University Department of Rural Health (UDRH) expects the notion of lifestyle choices to be an increasingly important trend in healthcare over the coming decades. Given the intricate confluence of economic, political and other factors that affect services, the idea of preventative healthcare is increasingly important for both patient quality of life and economic efficiency in the healthcare industry.
“There is a change with healthcare providers becoming partners with people in their care, which I think will mean more emphasis on the preventative aspects of health. For example, advising people about exercise and nutrition and helping them be knowledgeable about their health and how to self-manage their health needs.
“Chronic healthcare problems are a major part of current demand for healthcare. In response we are seeing more emphasis in training at places like CSU on the preventative, wellbeing aspects of healthcare to try and break that cycle and prevent chronic conditions being a major part of the population in 10–15 years’ time.
“Primary healthcare needs to be an increasing focus. This is where people can see the right practitioner straight away; keeping them out of hospital and treating them well in the community is where we should be looking. Because hospitals are expensive and there is a concern over the burgeoning costs of healthcare, so the more we can get people out of expensive institutions like hospitals, the better off we’ll all be.”
Meeting the healthcare needs of all Australians
Several of these strands of thinking about how to meet Australia’s future healthcare needs – such as more community-centred care, healthcare becoming more targeted to the specific needs of communities and patients within them, and preventative strategies – are relevant when considering healthcare for rural and Indigenous communities.
Traditionally, these communities have not been as well served by integrated healthcare services as other areas. This has been due to aspects such as the concentration of medical expertise in metropolitan areas, the geographic challenges of healthcare access and the economic factors associated with that.
However, in the coming years, there is likely to be an increasing expectation that the healthcare system (as with other aspects of society) should work for everyone.
This future drive to ensure good access to healthcare for rural communities will create opportunities for students to develop and augment their career, as outlined by Associate Professor Bernoth.
“Working in rural areas for our graduating students gives the opportunity to develop as leaders and very quickly move into more senior roles. Career progression is faster and they are learning more complex clinical skills because they are not reliant on ancillary services that are more available in metropolitan areas. One minute there may be a person with multiple traumas from an accident, the next a woman giving birth, the next someone who’s detoxing – they never know what’s going to come in the door, so they have to be skilled in a lot of areas.”
These opportunities are arguably magnified in healthcare work with Indigenous communities (who are predominantly rurally located).
Health outcomes are improving for Indigenous people in Australia, but by many measures they are still disadvantaged when compared to their non-Indigenous contemporaries.
For instance, the rate of community mental health service contacts for Indigenous people was 3.2 times the rate for non-Indigenous people. And 14 per cent of clients of publicly funded alcohol and/or other drug treatment services were Indigenous. A high proportion given that Indigenous people account for only three per cent of the country’s population.
So another key trend in the future of Australian healthcare could well be ensuring that the advantages and benefits of changes in healthcare provision are accessible and targeted at all members of the population.
But currently, as Margaret Yen, Lecturer in Health Services Management at CSU explained, with respect to Indigenous people, this isn’t always the case.
“Indigenous communities operate differently and a lot of our healthcare structures don’t respond well to such communities. That is a challenge that needs to be addressed: how healthcare meets the needs of the whole Australian community is a future challenge.”
Cultural sensitivity in healthcare
Dr Jessica Biles, Associate Head of the School of Nursing, Midwifery and Indigenous Health at CSU, said that Indigenous Australian cultural competence will be a key area of research and healthcare education in the future.
“We need to ensure that we have registered nurses and other health professionals that have training in their undergraduate degree, that they have the opportunity for skills, behaviours and attitudes to be developed so they can respond in a culturally appropriate way to, not only Indigenous Australian people, but also lots of other cultures.
“Typically, Indigenous Australian peoples present later or not at all in the disease process, which is a national problem. If we have registered nurses and other health professionals who are culturally inclusive and culturally sensitive and, better still, culturally responsive, we would reduce the cost of health and associated mortality and morbidity rates.”
As a regional university with inclusivity as one of its tenets of education, CSU is taking a lead in this area, with cultural competence embedded into courses, as Dr Biles explained.
“CSU has established an Indigenous Board of Studies so any content relating to Indigenous Australian people is submitted for review and approval by the Board of expert Indigenous Australian staff. This is extremely unique at a university level.”
Ms Yen gave an example of how this is applied during a course, detailing what master’s students in health services management do as part of their workplace learning.
“In terms of how we directly influence Indigenous communities in health services management, our master’s students are working as consultants with one of the local area health services in helping improve access for Indigenous communities. It involves students actively working with members of the Indigenous community, trying to create bridges between them and the area health service. Rather than imposing what we think on Indigenous communities, it is about empowering those communities to make their own decisions around healthcare.”
In healthcare, as with many other industries, perhaps the most far-reaching development that will enable healthcare workers to meet these challenges will be the integration of technology into healthcare provision.
The increase in technological capacity manifests itself in two main ways.
First, as Dr Biles explained, it provides patients with increasing access to information, and therefore understanding, about their own care.
“Rapid technological change will see enhanced consumer involvement in care. Consumers are becoming more of a partner in care. Healthcare professionals will need to be able to work within those partnerships. People are choosing the level of care they have, and from whom. Patients will increasingly have information, and will expect choice of care. Technology is obviously a major driver of access to information, and technology – in terms of things like telehealth – is being refined and developed all the time. One of the main drivers, that may not sound significant, will be the universal adoption of electronic medical records. Down to the level of instant access to, say, pathology results, means that ‘just in time’ care, having instant access to results and so the ability to direct immediate care, will change things.”
Second, Professor Rodney Hill, Head of the School of Biomedical Sciences at CSU, said that technology will allow for better directed and more efficient treatment services.
“Technology is going to continue to rapidly impact upon healthcare. Getting the right diagnosis early and then the triage to get the treatment the patient needs quickly will be aided by this development. Things like driverless cars, for instance, could have a major impact. If you have an emergency event, you could press a button to call a driverless car to take you to the hospital, and you’ll be sitting there and there’ll be monitors telling the hospital what your heart rate is.”
And at CSU, students get to work with technology during their studies to support this shift. As an example, students in the Bachelor of Podiatric Medicine are currently involved in the development of Riverina Shore, a new virtual community that allows health students to assess clients in real-world scenarios. Students liaise with real patients living in a rural community via digital communication technology.
However, as Professor Smith pointed out, technology is never an end in itself.
“No doubt technology will be a great help, particularly for rural communities. For instance, patients could take their own blood pressure and the results be transmitted live to a practitioner that they are communicating digitally with from their home.
“But technology can’t replace people; it must be used to its best advantage. Things like telehealth and videoconferencing are great aids, but we will still need people face-to-face to do things for patients.”
Associate Professor Bernoth echoed the sentiment.
“Technology is important, but we must always remember that healthcare is person centred. So while CSU has fabulous high-tech labs to learn in, we also ensure that students are exposed to patients, to people, through, for instance, clinical placements. We bring older patients into our tutorials to talk to students. Technology is great, but it must be integrated with the person at the heart of it.”
The way ahead for healthcare workers
So healthcare workers will still constitute the essential centre of healthcare service provision in the future, and demand for them will remain high.
As Professor Smith put it, “The way that the Australian population demographics are developing does mean that there will be a greater demand for people to work in health.”
However, healthcare workers in the future may need to be strategic in their thinking to maximise their career potential. Associate Professor Bernoth said, “Healthcare professionals are increasing in number to meet this demand, and there isn’t an oversupply, but students may have to think about geography and specialisation to secure the best career opportunities”.
There is likely to be oversubscription of some types of healthcare workers in certain areas, meaning wages and career progression could be suppressed. However, these will be localised, so having a flexible approach – and particularly exploring work opportunities in rural locations – is likely to provide the greatest scope for advancement.
However, the roles certain healthcare workers play in the industry will, in turn, have to adapt as well, as Dr Biles explained.
“In the future, a nurse’s role and scope of practice will increase. So healthcare professionals will need to develop leadership and management skills. And these extra skills will have value for the professional in a system that will be looking to maximise return on investment.”
And as the sector changes – with increased technological innovation – there is even more potential to find a niche, according to Professor Smith.
“Technology is creating new careers that previously perhaps weren’t even conceived of. For instance, researchers are currently developing a digital capsule that you can swallow that measures gas in your stomach and so can indicate any digestive diseases. So designing healthcare technology is a role students looking to work in health can consider, that those of previous generations might well not have been able to.
“Every one of our healthcare professions will have technology as an increasing part of what they do. For instance, physiotherapy now deals with robotics as part of a management strategy.
“Students need to be ready for practice now but also well prepared for the future. What that means is you teach someone how to adapt and respond to changes because we can’t know all the changes they will face over their career.”
A bright future?
Healthcare in Australia is already changing, and will continue to do so in the coming decades. Population demographics and their attendant demand on services, combined with economic imperatives and the integration of technology, mean the future of the industry presents both challenges and opportunities.
Meeting the needs of an ageing population who make more demands on healthcare services – potentially with a smaller tax base of working-age people to pay for it – will require a growth in dynamic services, delivered by agile workers able to respond to change positively. These workers will also be at the forefront of applying the latest trends in research around ageing and lifestyle choice, and healthcare programs that meet the needs of Australians in areas that might previously have been under-resourced. Equity will be a major tenet of future healthcare.
Growth in the industry will mean opportunities for those looking to work in the field. Just in terms of nursing, in the medium to long term Australia’s demand for nurses will significantly exceed supply, with a projected shortfall of approximately 85,000 nurses by 2025 and 123,000 nurses by 2030.
The essential part that the healthcare industry plays in everyone’s life means that investment and research will be significant, opening up further possibilities for change and making a difference during a career in healthcare.
The prospect of designing, building or delivering new ways of providing healthcare, something so essential to everyone, means it is an exciting time to consider a career in the healthcare industry – whether in allied health, nursing or medical science – and to play a part in shaping its future.
Maree Bernoth is an Associate Professor of Nursing in the School of Nursing, Midwifery and Indigenous Health, with a research and teaching focus on aged care and healthy ageing.
Professor Megan Smith was appointed to the position of inaugural Director, Three Rivers UDRH in July 2017. Her research interests are in the area of developing a future rural health workforce that is able to meet the health needs of rural communities.
Margaret Yen is a lecturer in Health Services Management. Her current research focuses on the role of nurse managers.
Dr Jessica Biles is the Associate Head of the School of Nursing, Midwifery and Indigenous Health. Her research focuses on effective teaching strategies in Indigenous Australian cultural competence.
Professor Rodney Hill is Head of the School of Biomedical Sciences. He has a strong record of research and teaching, and in building multidisciplinary healthcare education programs.