Panzera Annette June, Murray Richard, Stewart Ruth, Mills Jane, Beaton Neil, Larkins Sarah
James Cook University, College of Medicine, JCU Cairns Clinical School, Cairns, Qld 4780, Australia.
James Cook University, Douglas Campus, Townsville, Qld 4811, Australia.
Aust J Prim Health. 2016;22(1):63-68. doi: 10.1071/PY15149.
Creating a stable and sustainable health workforce in regional, rural and remote Australia has long been a challenge to health workforce planners, policy makers and researchers alike. Traditional health workforce planning is often reactive and assumes continuation of current patterns of healthcare utilisation. This demonstration project in Far North Queensland exemplifies how participatory regional health workforce planning processes can accurately model current and projected local workforce requirements. The recent establishment of Primary Health Networks (PHNs) with the intent to commission health services tailored to individual healthcare needs underlines the relevance of such an approach. This study used action research methodology informed by World Health Organization (WHO) systems thinking. Four cyclical stages of health workforce planning were followed: needs assessment; health service model redesign; skills-set assessment and workforce redesign; and development of a workforce and training plan. This study demonstrated that needs-based loco-regional health workforce planning can be achieved successfully through participatory processes with stakeholders. Stronger health systems and workforce training solutions were delivered by facilitating linkages and planning processes based on community need involving healthcare professionals across all disciplines and sectors. By focusing upon extending competencies and skills sets, local health professionals form a stable and sustainable local workforce. Concrete examples of initiatives generated from this process include developing a chronic disease inter-professional teaching clinic in a rural town and renal dialysis being delivered locally to an Aboriginal community. The growing trend of policy makers decentralising health funding, planning and accountability and rising health system costs increase the future utility of this approach. This type of planning can also assist the new PHNs to commission health services that meet the needs of the population and contribute to service and system improvement and innovation.
长期以来，在澳大利亚的地区、农村和偏远地区建立稳定且可持续的卫生人力队伍，一直是卫生人力规划者、政策制定者和研究人员面临的挑战。传统的卫生人力规划往往是被动反应式的，并且假定当前的医疗服务利用模式会持续下去。昆士兰远北地区的这个示范项目，例证了参与式区域卫生人力规划过程如何能够准确地模拟当前及预计的当地人力需求。近期成立的初级卫生保健网络（PHNs）旨在委托提供针对个体医疗需求的卫生服务，这凸显了这种方法的相关性。本研究采用了受世界卫生组织（WHO）系统思维启发的行动研究方法。遵循了卫生人力规划的四个循环阶段：需求评估；卫生服务模式重新设计；技能组合评估与人力重新设计；以及制定人力和培训计划。本研究表明，通过与利益相关者的参与式过程，可以成功实现基于需求的地区性卫生人力规划。通过促进基于社区需求的联系和规划过程，涉及所有学科和部门的医疗专业人员，从而提供了更强有力的卫生系统和人力培训解决方案。通过专注于扩展能力和技能组合，当地卫生专业人员形成了一支稳定且可持续的当地人力队伍。这个过程中产生的举措的具体例子包括，在一个农村城镇建立一个慢性病跨专业教学诊所，以及在当地为一个原住民社区提供肾脏透析服务。政策制定者将卫生资金、规划和问责制下放的趋势日益增强，以及卫生系统成本不断上升，增加了这种方法未来的实用性。这种类型的规划还可以帮助新的初级卫生保健网络委托提供满足人群需求的卫生服务，并有助于服务和系统的改进与创新。
