Understanding and Enhancing the Preparedness of Medical Technicians of the Royal Australian Army Medical Corps

Health Workforce Readiness – understanding and enhancing the preparedness of Medical Technicians of the Royal Australian Army Medical Corps George A Georgiadis A thesis towards the degree of Professional Doctorate in Public Health School of Public Health and Community Medicine Faculty of Medicine 2018 Copyright and Authenticity Statements ii Dissertation sheet iii Originality Statement iv Dedication This research is dedicated to the soldiers of Royal Australian Army Medical Corps who have given, and continue to give selfless service supporting the men and women of the Australian Army since before Federation. v Abstract Health workforce preparedness relies on effective management of, and investment in an organisation’s workforce. As the largest clinical craft group in the Australian Army, Medical Technicians provide health care from point of injury; as independent health practitioners, through to mobile or fixed medical facilities as members of multi- disciplinary health care teams, usually at short notice. By examining the preparedness of the Australian Army’s Medical Technician workforce, this research presents a conceptual model for developing and maintaining a high readiness and adaptive health workforce. Through a mixed methods convergent design, this study addresses the question of how to develop and maintain a high readiness and adaptive health workforce by examining the human capital areas of training and development, skills and knowledge maintenance. While human capital is generally limited to the skills, knowledge, and attitudes embodied in individuals, to be effective, human capital management must also consider workforce retention. The lived experiences and perceptions of 179 Medical Technicians from Private to Warrant Officer Class Two were examined, using a mixed methods survey instrument, open forum discussion, and eight focus group discussions. The research findings suggest that current Medical Technician training model is flawed by focusing on “front loading” soldiers with all the skills, knowledge, and attitudes they may require throughout their career, during their initial training. The trade model does not incorporate the concept of lifelong learning, or consider how one’s work changes as Medical Technicians are promoted. The study found that training towards nursing and paramedicine qualifications, and registration is failing to prepare Medical Technicians for the work they undertake for the majority of their time, primary care. It also found that operational tempo, the current approach to training, skills maintenance and professional development is a contributing factor to the high turnover of Medical Technicians at the ranks of Corporal and Sergeant. vi This research recommends a review of current Medical Technician training and proposes a range of skills and knowledge development and maintenance initiatives that are evidence based, which will improve Medical Technicians preparedness in the Australian Army, and which can be applied to other high-readiness health workforces. vii Acknowledgements This research was made possible through the support and assistance of so many people. Firstly, I would like to acknowledge and thank my academic supervisors, Professor Raina Macintyre and Associate Professor David Heslop, for without their encouragement, advice, and guidance this research would never have seen the light of day. I must especially acknowledge and thank Associate Professor Graham Durant- Law, my workplace research supervisor, who not only taught me the value of knowledge, but encouraged me to question and challenge everything in the pursuit of knowledge and understanding. I must also thank the following work colleagues for their support and encouragement over the past three and a half years: Major General Jeff Sengelman, Major General Marcus Thompson, Brigadier Leonard Brennan, Brigadier Susan Coyle, Brigadier Paul Nothard, Brigadier Georgeina Whelan, and Colonel Fleur Froggatt. I also thank the Commanding Officers of the 1st Close Health Battalion and the 2nd General Health Battalion, Colonel Caitlin Langford and Lieutenant Colonel Clark ‘Barney’ Flint. A special thanks to Lieutenant Colonel Maureen Montalban, Major Tracy Allison, Major Damien Batty, Major Natasha Robinson, Major Lynda White, Captain Natalie Lehmann, Warrant Officer Class One Cheryl Elston, and Warrant Officer Class One Dave Leak for their support, understanding and assistance during my research. I would also like to thank all the officers and soldiers who participated in this research by completing lengthy surveys and taking part in endless group discussions. Finally, and most importantly I must thank my wife Kim and our three daughters, Stephanie, Caitlin and Jessica. For without their love, support and understanding this adventure, not unlike all others in life, would not have been possible. Everything I have achieved, both professionally and academically is due to them. Thank you. viii Abbreviations ADF Australian Defence Force AHI Army Health Instruction AHPRA Australian Health Practitioner Regulation Agency AHS Army Health Services AQF Australian Qualification Framework ASH Army School of Health CPL Corporal DoD Department of Defence FIC Fundamental Inputs to Capability JHC Joint Health Command KIA Killed in Action LCPL Lance Corporal Med Tech Medical Technician Medic Medical Technician NATO North Atlantic Treaty Organisation NHMRC National Health and Medical Research Council PTE Private RAAMC Royal Australian Army Medical Corps SGADF Surgeon General Australian Defence Force SGT Sergeant TCCC Tactical Combat Casualty Care WHO World Health Organisation WO2 Warrant Officer Class Two ix Table of Contents Copyright and Authenticity Statements .................................................................. ii Dissertation sheet ................................................................................................. iii Originality Statement ............................................................................................ iv Dedication ............................................................................................................. v Abstract ................................................................................................................ vi Acknowledgements ............................................................................................ viii Abbreviations ....................................................................................................... ix Table of Contents................................................................................................... x List of Figures ....................................................................................................... xv List of Tables ........................................................................................................ xvi Chapter 1: Introduction .......................................................................................... 1 Part 1: Overview .......................................................................................................... 1 Background ....................................................................................................................... 1 Rationale for this research ................................................................................................ 4 Hypothesis and Research Question .................................................................................. 5 Scope and limitations of this research .............................................................................. 6 Thesis structure ................................................................................................................. 7 Part 2: Situating the Research ....................................................................................... 8 Overview ........................................................................................................................... 8 Nature of Military Operations ........................................................................................... 8 Australia’s Strategic Context ........................................................................................... 10 The Australian Defence Force ......................................................................................... 11 Generation of Capability ................................................................................................. 11 Preparedness ................................................................................................................... 14 The Australian Army ........................................................................................................ 16 The Royal Australian Army Medical Corps ...................................................................... 19 Evolution of Military Medicine ........................................................................................ 21 Medical Technicians ........................................................................................................ 29 Training, Education and Development in the Australian Army....................................... 34 Clinical Readiness Standards for Army Health Services Personnel ................................. 36 Summary ......................................................................................................................... 38 x Chapter 2: Literature Review...............................................................................

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