6.3.1 Leadership

People in leadership positions in RCSs and UDRHs play a crucial role in three important arenas:
  • Leaders represent and advocate for new models of training which challenge the long-established metropolitan models of the professions and the university (a particularly critical issue in medical training, but also relevant in nursing and allied health).
  • Leaders inspire and support rural practitioners to participate in the program as trainers and supervisors, and have sought to develop academic opportunities such as joint appointments so practitioners have an additional motivation to stay in the rural location.
  • Leaders build collaborative relationships with the State/Territory health services (at a clinical and management level), with local private health providers (including Aboriginal Health Services), and with community stakeholders such as Shire councils, Rotary clubs, etc.
The biggest asset is also the biggest risk - people. (UDRH academic)
As with any organisation, the capability and capacity of its people and their ability to work together as a highly functioning team determine the organisation’s long-term success. As discussed throughout this report, the leadership within the Programs has been critical in building up the individual sites across the country. It is reasonable to expect that some of those who have been key champions or pioneers of the Programs will choose to move on from their current positions within the next five to ten years if they have not already. Accordingly, it is essential that plans are in place to ensure that relationships with external partners are embedded within the organisation rather than resting with the personal credibility of individuals.

One of the ways in which the Programs can do this is to build on their organisational learning culture, encouraging professional development and capacity building within their own staff. This has the secondary effect of developing a cohort of leadership capacity within rural communities, which has the potential to benefit the rural health sector, the university sector, and the local community. Developing leadership capacity within the ranks will also contribute to succession planning.

One of the ways in which the Programs can do this is to build on their organisational learning culture, encouraging professional development and capacity building within their own staff. This has the secondary effect of developing a cohort of leadership capacity within rural communities, which has the potential to benefit the rural health sector, the university sector, and the local community. Developing leadership capacity within the ranks will also contribute to succession planning. One of the strengths of both Programs, but particularly the UDRH Program, is the variety of ways in which the UDRHs and RCSs have responded to and adapted to local circumstances and challenges. The ethos of each site is slightly different and determined as much by the way in which the leadership have responded to their mandate in the local context as to the national Program objectives or parameters. Organisational vision is highly influenced by the leader of the organisation, and there is a natural risk to both Programs of losing the early passion and vision of the founders as the individual UDRHs and RCSs become more established. Developing and articulating a strategic vision for the national Program (discussed later in section 6.4.2) will assist in ensuring stability as leaders change.

At the same time, strategic leadership within the potentially isolated contexts in which RCSs and UDRHs operate is difficult, and universities can provide structural and professional support to assist those in leadership positions who are in the process of creating new and innovative rural health training systems, to avoid burnout and to encourage others to follow in their footsteps. This is not a financial obligation of the universities as much as an opportunity to embed the Programs further in the structures of the universities in order to ensure UDRH and RCS staff are integrated into the larger enterprise of health education and training.

Recommendation 1:

That the universities support and encourage the professional development of RCS and UDRH Program staff to ensure stability and the mentoring of new leadership.

6.3.2 Succession planning

Recruitment for UDRHs and RCSs is as difficult as it is for health services in rural areas; this is an indication of the challenges currently faced across rural Australia and is likely to remain so for some time. However, UDRHs and RCSs have the additional attraction of offering joint academic and clinical appointments which may be attractive to a cohort of students already pre-disposed to rural practice. The ability to attract younger, academically oriented people to take positions was a concern for many informants.

'Research funding isn't enough to attract them, we need a broader range of investments'. (UDRH academic)
'A major psychological issue in rural areas is critical mass - you need to know there's back-up, if you want to take any time off, to not be on call all the time. You will get doctors coming to rural areas if you can offer them an academic package.' (RCS academic)
In other words, the Programs need to continue to be innovative in order to be seen as an attractive career opportunity for young researchers and early career clinicians. Opportunities for ongoing professional development as well as lifestyle benefits were named as some of the factors in Program staff's career decisions.

It has also been noted that flexibility with the expenditure of funding is required; sometimes funding is received for positions but a time lapse ensues before implementation due to the difficulty in recruiting an appropriate person to undertake the role. In some cases it has taken a year or more to recruit a suitable person to fill an academic and/or clinical appointment. (Refer to the case study 'Border Medical Recruitment Taskforce' in section 5.4.2 for an example of regional recruitment strategies.)

The challenges of recruitment reinforce the need for UDRHs and RCSs to collaborate with area health services and other agencies to develop strategies for attracting high-quality people to take up rural appointments, for the benefit of the Programs as well as local health service delivery. This point is discussed further in sections 6.6 and 6.7.2.

6.3.3 Structural sustainability

The participating universities have benefited from Commonwealth funding for the Programs to establish a university presence in regional and rural Australia. The Department of Health and Ageing has provided funding for infrastructure which would not have been available to universities otherwise (such as office and teaching space, accommodation, clinical simulation laboratories, and information technology facilities).

This infrastructure has had broad benefits not only for the health sector, but also the educational sector, heightening the universities' visibility within communities and engendering a positive response towards the university through their presence in the local community. External stakeholders have expressed community perceptions that the rural environment is valued by the university because of this tangible investment in the provision of rural university sites.

However, there are questions regarding the sustainability of the current arrangements. A number of UDRH staff pointed out that there is no funding for maintenance of capital works, so that when maintenance is required it impacts upon core funding. Some informants reported a perception that, because of the external funding source of the Programs, the university did not feel the same ownership of the Programs as they might for other, metropolitan-based departments.

'It's been more like a growth on the university than a growth of the university.' (UDRH staff member)
As noted in sections 4.4.2 and 5.4.2, senior university informants universally believed that the Programs were making a positive contribution to the rural health workforce, and that the Programs had benefited the universities by allowing them to develop academic infrastructure which enhanced their visibility and credibility within rural and regional Australia.

One senior university representative stated that the continuity of Commonwealth funding was critical in order to achieve the scale of operations which the Programs currently undertake. A senior representative of another university also stated that 'DoHA has a better understanding of workforce issues', and that it was preferable for the Programs to be funded through the Department rather than through DEEWR as the workforce priorities of the Programs differentiated them from the rest of the university sector. One UDRH Head commented that:

'the UDRHs are a hybrid group - not standard education providers because they are service-oriented. They need not to be put into [the education sector] solely because they are also providing research and service improvements. Their strengths are operating at both levels'.
This perception of being 'embedded into local services' was considered by most UDRH and RCS leaders to be a critical component of their ability to support the rural workforce. While they are not necessarily easily defined because of this straddling of both the educational and workforce sectors, this dual nature may in fact be the key to their sustainability, informing the education sector regarding health system needs and facilitating ongoing educational and professional development within the health sector. Maintaining this delicate balance of identifying with both the academic sector and the professional health sector appears to be crucial for both UDRHs and RCSs to bridge the gap between training students for clinical practice and sustaining an effective and functioning rural health system. Most university informants considered that the Programs would not be sustainable without continued funding from the Department, both because of the financial investment required but also because of this dual nature of the Programs as both workforce and educational initiatives.

Recommendation 2:

That the Department maintain its current funding arrangement of the two Programs, maintaining the Programs as distinct health workforce initiatives within the academic sector.