Andrew Leigh

Here's my speech from this morning, officially opening the Allied Health Professions Australia national conference on behalf of Health Minister Tanya Plibersek. My focus was on how we often place too much emphasis on individual, and not enough on teams. It's a theme that doesn't just apply to healthcare.

‘Teamwork and Healthcare: The Role of Allied Health Professions’
Speech to Allied Health Professions Australia (AHPA) Conference

Andrew Leigh
Federal Member for Fraser
www.andrewleigh.com

Realm Hotel, Canberra
2 April 2012

[Acknowledgements omitted]

Introduction

Let me start with a story.

In 1999, a three-year old girl was out walking with her parents in a small Austrian town of Klagenfurt.[1] They lost sight of her for a moment, and she fell into an icy fishpond. Her parents jumped in after her, but it was 30 minutes before they found her on the bottom of the pond.

Following instructions from an emergency team they called on their mobile phone, they performed CPR and called rescue personnel, who flew her by helicopter to the nearest hospital, performing CPR all the way. On arrival, she had no blood pressure, no pulse and no breathing. Her body temperature was 19 degrees.

As quickly as they could, the team connected the girl to a heart-lung bypass machine. By the time it started to pump oxygenated blood to her body, she had been lifeless for 90 minutes. After 6 hours, her body temperature was normal, but there was too much water in her lungs to use a mechanical ventilator. So they switched her to an artificial lung system called ECMO – extracorporeal membrane oxygenation. This involved opening her chest with a  power saw, and sewing the lines directly into her heart. With her chest still open, the intensive care team worked on removing pond water and debris from her lungs with a fibreoptic broncoscope.

Over the next two days, the girl’s major organs recovered. But they were worried about her brain. There was global swelling, but no dead zones. So they drilled a hole into the girl’s skull, inserted a probe to monitor the pressure, and slowly adjusted her fluids and medications until it returned to normal.

After a week, the girl began to breathe on her own. Soon after, she woke up. Two weeks after being admitted to hospital, she went home. She still had some paralysis in her arm and leg, and her speech was slurred. But with extensive therapy, she had made a full recovery by age 5.

In his book The Checklist Manifesto, medical writer Atul Gawande points out how extraordinarily complicated the girl’s rescue was. To save one child, scores of people have to keep lines sterile, replace batteries, keep air bubbles out of the heart, and engage in painstaking occupational therapy. Yet a small Austrian hospital was able to save a girl who had lain at the bottom of a pond for half an hour. They did it not because of one great surgeon (as you might on TV), but because they recognised the need for all the parts of the medical system to work together.

In the years before this girl had come in, the hospital in Klagenfurt had tried to treat 3-5 patients a year who were suffering from cardiac arrest. But no matter how hard they tried, something seemed to fail. They often found a key person or action missing. It was only when the hospital instituted a checklist, which set out all the key actions and people required, that they began to save lives.

Teamwork

As allied health professionals, you know in your bones the value of teamwork. I believe we – the Australian Government and the allied health professions – share the same objectives for Australia’s health system.

The theme of your conference, ‘Strengthening Health Outcomes’ speaks to the challenges facing Australia’s health system, and the opportunities to work together to help Australians live longer and healthier lives.

• We want the best-quality health care delivered to Australians when and where they need it.


• We want to build the capacity of the health workforce and system.


• And we want health reforms to be sustainable.

Current pressures on the health system

As the Australian population ages, we are looking at an alarming and growing list of complex and chronic illnesses.

With advances in systems and technology, Australians also expect more of our health system.

We need to help and encourage Australians to manage their own health to a greater extent than ever before.

We want to keep them healthy as long as possible and out of hospital care by boosting their long-term health outlook and general wellbeing.

These pressures were key factors in the most far-reaching and systematic review of our health system – through the National Health and Hospitals Reform Commission, the Preventive Health Taskforce and development of the National Primary Health Care Strategy.

Current Medicare support and other support for allied health

The Australian Government is committed to building a stronger primary health care system which values the role of allied health care providers.

Medicare rebates for allied health services are available to: patients who have a chronic or terminal medical condition and complex care needs requiring multidisciplinary care, and who are managed under the relevant Chronic Disease Management  (CDM) care planning items; and to Indigenous patients who have had a health assessment.

These items enable GPs to plan and coordinate the health care of patients with chronic or terminal medical conditions, and where necessary, refer patients for allied health services under Medicare. That’s the system working collaboratively.

Last year, more than 7 million services were provided through the CDM and associated allied health items. That’s one service every
3 seconds.

These Medicare services were introduced to complement services provided by state and territory governments, and to increase access to private allied health services.

The Australian Government also supports access to allied health services by subsidising private health insurance premiums and through targeted programs such as the Rural Primary Health Services Program.

The Government will continue to provide ongoing support to train, educate and retain our allied health workforce.

The new health environment & allied health

But we also want to make important changes.

We want to see more effective care - outside of hospital where appropriate - focussing on preventing disease and modifying lifestyle.

We have committed to a range of initiatives under the National Partnership Agreement on Preventive Health – the largest investment an Australian government has ever made in health prevention.

The aims of the National Health Reform Agreement are consistent with tackling differences in health services and outcomes:

• improving the efficiency of public hospitals – using activity-based funding based on a national efficient price;


• standards of clinical care through the Australian Commission on Safety and Quality in Health Care;


• local accountability and responsiveness to communities’ needs by establishing Local Hospital Networks and Medicare Locals; and


• providing GP and primary health care services by developing an integrated primary health care system.

Primary health care reform

Our reforms within primary health care aim to shift the centre of gravity from hospitals.

This includes fast-tracking reforms to GP after-hours primary health care services, and bringing forward more Medicare Locals.

Medicare Locals are particularly significant for allied health professionals, focusing as they do on local communities’ health care needs.

Patients will benefit from a smoother transition, in and out of hospital, and by receiving the right care, in the right place, at the right time. That’s medicine working as a team.

The AHPA will have an important role – working with the Government, Local Hospital Networks and Medicare Locals to establish effective collaborations and to support allied health professionals developing local networks.

E-health

Allied health professionals continue to be involved in e-health ­– an important element of national health reform. Working with AHPA, we have invested significantly in research to better understand the position and readiness of allied health professionals for e-health.

We have published a landmark study on the readiness for e-health of more than one thousand allied health professionals.

GP Super Clinics

Allied health professionals, as part of primary health care teams including GPs and nurses, will have opportunities through GP Super Clinics to provide integrated, multidisciplinary primary health care services to local communities in one location.

Incentives are available for allied health services to relocate to newly-opened GP Super Clinics – discounts on rent, centralised administration services and IT support.

At the end of January, nurses and allied health professionals were providing services for about one-third of the presentations at operational GP Super Clinics.

A number of clinics offer preventative health services – lifestyle modification programs, women’s health services, diabetes clinics and smoking cessation programs. Good health requires collaboration across the sectors.

Health workforce

The future contribution of allied health professionals to the health system is also being taken into account in planning of the health workforce.

Health Workforce Australia (HWA) is doing this through four main areas:  workforce planning, policy and research; clinical education; innovation and reform of the health workforce; and the recruitment and retention of international health professionals.

In 2012, HWA will begin National Training Plan Mark 2. This will analyse, in selected groups of allied health professionals, how future workforce demand for these professions up to 2025 will be affected by improved workforce retention, increased productivity and innovative health reform measures.

HWA will also start work shortly on projects which seek to look at the role of allied health professionals in a variety of settings.

Conclusion

Let me finish with another story.

In 2009, US Airways flight 1549 took off from La Guardia airport in New York.[2] It was an Airbus 320, with 2 engines. About 90 seconds after takeoff, it struck a flight of Canadian geese. At least 3 geese (weighing around 5kg apiece) went into each engine. Both stopped.

Now all of you know what happened next. The plane, piloted by 57 year-old Captain Sullenberger, glided for 3½ minutes before landing safely in the Hudson river. All 155 people on board survived. It is the most successful ditching in aviation history.

In the press write-up afterwards, the focus was on the pilot. He had flown gliders for the air force, and the media saw him as the hero of the moment. Captain Sullenberger was phoned by President Obama. Every TV talkshow wanted to feature him.

Yet the story is actually one of teamwork. When crash investigators look at aircraft disasters, a common theme is a failure to work together. In the case of Flight 1549, cockpit voice recorders show that success occurred because the pilot, co-pilot and 3 flight attendants worked together. For those crucial 3½ minutes as the pilot turned the plane past Manhattan skyscrapers, the co-pilot made preparations for landing, and worked to restart both engines. The flight attendants got the passengers into brace position, and made sure they were ready to don their life jackets. 155 lives were saved that day not because of a great pilot, but because of a great team.

As allied health professionals, you are committed to primary health care and to improving the health of patients.

I leave you with this key challenge: engage with the health reforms; take up the opportunities offered by eHealth; and finally, establish links with the key organisations in your local area, particularly Medicare Locals, but also more broadly with other primary health care organisations like GP Super Clinics and individual health care providers. Success in healthcare, as in so many other areas of life, is about making great teams even better.

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[1] Markus Thalmann,  Ernst Trampitsch, Norbert Haberfellner, Elisabeth Eisendle, Raimund Kraschl, Georg Kobinia, 'Resuscitaton in near drowning with extracorporeal membrane oxygenation', Annals of Thoracic Surgery 2001 72: 607-608. Cited in Atul Gawande, The Checklist Manifesto, Macmillan, New York, 2009.
[2] As told in Atul Gawande, The Checklist Manifesto, Macmillan, New York, 2009.