Responding to health skills shortages: Innovative directions from vocational education and training

This study examines how the vocational education and training (VET) sector can respond to skill shortages in the health sector. The study focuses largely on VET-trained workers in the health industry, such as enrolled nurses, nursing assistants, personal care assistants, allied health assistants and Aboriginal and Torres Strait Islander health workers.

• Responsibility for addressing skills shortages should be jointly shared between the health sector, education and training organisations and government, with industry and employers taking a proactive role. A partnership approach is necessary to provide the commitment and breadth of human, infrastructure and financial resources necessary for addressing skills shortages sustainably.
   
• Industry-driven approaches are a recurring characteristic of well-developed and effective models for addressing skills shortages.
   
• Innovative models first consider the tasks involved in the skills shortage, identify the requisite competencies, then design the training and/or redesign the job.
   
• Targeted training appears to be most effective in meeting skills shortages. Training components of programs within organisations should be complemented by a focus on retention of workers, increased job satisfaction and better career paths.
   
• There needs to be a mix of short-term solutions (training only) and medium-to-longer-term solutions (job redesign, holistic approaches).

Introduction

This study examines innovative approaches from the vocational education and training (VET) sector in response to skill shortages in the health sector. ‘Innovative’ models are defined as models which introduce something new into the context and/or make a change in something established; for example, training in a context where there was no training before, or redesigning jobs and providing training for new skills.

The study focuses largely on VET-trained workers in the health industry, such as enrolled nurses, nursing assistants, personal care assistants, allied health assistants and Aboriginal and Torres Strait Islander health workers.¹ Although considered part of the community services sector, aged care workers are included, because qualifications and training in this area appear to be increasingly forming a training and career pathway for health workers. The selected occupations are linked to VET qualifications that are part of the Australian Qualifications Framework, with a focus on certificates II to IV and diploma-level training.

The current structure of the national health and community services workforce has several characteristics that differentiate it from the labour forces of many other industries. In particular, there has been an adjustment of the mix of occupations in nursing toward lower-paid occupations. Personal care workers now form the bulk of the aged care workforce, while allied health assistants almost doubled from 1996 to 2001. There are persistent job vacancies and overtime in the health sector, as well as poor retention and pay rates. Women make up 78% of the health workforce, and the workforce is ageing.

The study considers how the problem of health skills shortages requires a multi-faceted approach from government, the education sector and industry, drawing on the Productivity Commission (Productivity Commission 2005) report on Australia’s health workforce.

The study consisted of four stages. Stage 1 identified and analysed statistics and literature on the structure of the national health workforce and perceived skill shortages in health. Stage 2 identified when and where skill shortages in health have been addressed with innovative and effective models. Models were identified from the literature and an internet and database search, supplemented by a request for nominations from key contacts in health. Some innovative international programs addressing skills shortages and with the potential to be aligned to the Australian VET system are also included. In the third stage 50 models which appeared to be effective in addressing the areas of skill shortage were selected for further analysis. Information from public sources was used to write brief summaries. Six of the 50 models were then selected for writing up as case studies. The 50 effective models and the case studies are included in the support document accompanying this report.

Findings

Two overarching themes to emerge from the literature are the use of a partnership approach to address skills shortages and the targeting of specific groups for training and employment. At a national level the partnership approach is being promoted through the National Skill Ecosystem project (ANTA 2005). Strategies include but are not restricted to training solutions. Partnership approaches in which health providers work with communities are noted as particularly relevant in rural and remote communities, where access to resources is limited (Cunliffe 2004). At a national level, there is a focus on addressing unemployment and underemployment issues amongst disadvantaged groups of potential employees, such as the disabled, those over 45 years of age, and those from culturally and linguistically diverse backgrounds, by targeting them for training or retraining to fill skill shortages in the health and community services sector (Department of Education, Science and Training 2003).

This project found 74 models which were developed in Australia and internationally as a response to skills shortages in health. Using a typology that incorporates Perri’s (1993) three levels of innovation², three categories of models were identified according to the mix of activities involved: training only; job and/or workforce redesign and training; and holistic. Most models were training only, followed by job and/or workforce redesign and training. Only about one in ten were holistic. Most were in rural/regional areas where skills shortages and the need for innovative, partnership-based solutions is the greatest.

In the ‘training only’ group, the vast majority were targeted training, many in the aged care sector. Target groups are VET in Schools students, youth, special needs groups (including Aboriginal and Torres Strait Islander people, rural and remote, and older workers), and people returning to the workforce after an absence.

Job and/or workforce redesign and training models involve upskilling and providing career pathways for existing workers, mobility across health roles in line with multi-disciplinary team-based approaches to care, and the creation of new health worker roles.

Holistic approaches are overarching and medium-to-long-term, and are largely designed to address protracted skill shortages in a sustainable manner. They cover relatively large geographical regions, include multiple stakeholders engaged in ongoing consultation, and employ a range of solutions to skill shortages in addition to training (such as job redesign, industrial relations and the effects of skill shortages in supply chains).

Findings of the project suggest that a mix of short-term solutions (training only), and medium-to-longer-term solutions (job redesign, holistic approaches) is required in order to meet existing and projected future skills shortages.

The project found that the characteristics of effective models include the following.

• Collaboration and partnerships: this means that responsibility for addressing skills shortage is jointly shared between the health sector, education and training organisations and governments, with industry and employers taking a proactive role. Partners have a high level of commitment and effective communication channels.
• Industry involvement: a hallmark of a well-developed model is demonstrated responsiveness to industry needs. Innovative models first consider the tasks involved in the skills shortage, identify the requisite competencies, then design the training and/or redesign the job. Health and aged care facilities are strongly involved in the development of training and job-redesign models.
• Flexible delivery of training: this tends to increase the accessibility of training, especially for rural and remote trainees, but also for workers in metropolitan centres.
• Pathways to and from other training: these increase the expertise of the health workforce and also facilitate succession planning within organisations.
• Transferability: although the models develop from local collaborations and are customised to local needs, replicability of core processes in their development and implementation can occur elsewhere in contexts of similar need.

There were some recurring issues relating to barriers or challenges to developing the models. These included the requirement for both policy and organisational flexibility to accommodate changing workplace needs and to support collaborative solutions to skill shortages.

Implications

The implications of this report are relevant to stakeholders at all levels. Everyone needs to be aware of what is being done—the effective processes that enable solutions, the potential for transferability to new sites, the barriers to innovation—and the implications of this for policy and practice. All partners need to share responsibility.

At a system-wide level there is a need for sustainable funding for innovative solutions to skills shortages in the health services. One element of this is an investigation of specific funding to cover clinical placements. Much training depends on completing clinical placements. Ongoing skills shortages amongst health professionals will also impact negatively on clinical placement availability.

If the models are to be transferable, information about them must be disseminated to give organisations the opportunity to learn from one other. Furthermore, it is important that consumers and the broader community are informed of the advent of new roles and service delivery models in this industry. Program stakeholders need to be mindful of their responsibilities for dissemination of information to the wider world. The Industry Skills Council, the Department of Education, Science and Technology and state training authorities are well placed to assist in dissemination.

Effective models make use of aspects of the VET system that allow for flexibility and customisation of training. At the same time there is a need for flexibility in the endorsement and accreditation of programs. This has become a time-consuming and cumbersome process for developers of some models, to a certain extent inhibiting program innovation.

Implications for resourcing include the need for organisations to support an appropriate level of risk-taking in developing new models. Resourcing also involves adequate and ongoing funding and human resources to enable partnership work. Skills for working collaboratively must be developed. Where practicable, co-location and other structures, such as regular network meetings, should be considered.

It is imperative that solutions to health skills shortages be industry-driven. Industry’s involvement in model development will emphasise the practical. The process involves: first, a consideration of the tasks involved in the skills shortage and identification of the requisite competencies, then design of the training and/or redesign of the job. Skills of trainees and trainers must also be considered. In the early development stage unions and workers need to be involved in order to overcome possible issues relating to organisational boundaries.

Targeted training appears to be most effective in meeting skills shortages. Training components of programs within organisations should be complemented by a focus on retention of workers, increased job satisfaction and better career paths.

Evaluation needs to be built into models from the development stage, and sufficient resources allocated to this process. Quantitative measures such as outputs and low-level outcomes need to be supplemented by qualitative measures such as case studies, which capture the interactions and processes of the initiative as it builds to the desired longer-term outcomes. Feedback from evaluation needs to be far more rigorous and should include input from all stakeholders on model effectiveness and suggestions for improvement. Evaluation enhances continuous improvement and sustainability of models.

¹ For explanation of these job classifications, see Full Report, Glossary, p.38.

² Perri’s three levels of innovation are: radical (a wholly new way of delivering services); differentiated service (existing delivery changed into something different); and differentiated labour market segment (existing service provided to or by new group).