One of the factors in the success of the Programs to date has been the Department's approach to the Programs in their implementation. Departmental staff were considered to be approachable, flexible and understanding when operational challenges arose, and this was believed to be appropriate in fostering the establishment of ambitious and fledgling Programs which had not been trialled before. The continuity of Departmental staff overseeing the Programs over time has also been noted favourably. For both Programs this approach has encouraged the enthusiasm and innovation which have characterised the development of the Programs nationally. Some stakeholders expressed concern that a change in the Department's approach, for instance away from openness and flexibility, would inhibit the ability of the Programs to be responsive to their local environments and the needs of their communities.

Some stakeholders were aware of the need for the UDRHs and RCSs to maintain their ability to innovate and create new opportunities or risk losing the level of financial and professional support that has been critical to the success to date.

'[we need] to add value in a whole range of different ways; simply teaching alone as an activity is not enough of an activity for a rural clinical school nor is it likely to produce the kind of workforce impact. We have got to be involved in service development and involved in the services in a whole range of different ways so that our role infiltrates both practice and teaching. So there's a very important dual role and I think that's a critical sustainability issue. I don't think we can just sit here as teachers, I think we have to be very, very involved in the overall development of health services throughout the region and I think we’re doing that to some extent.' (RCS academic)

Along these lines, a recent study (Edmondson 2008) analysed the difference between efficiency and learning in organisational practice. The author argued that organisational cultures that are focussed on efficiency risk losing the ability to remain competitive, or (for hospitals and other complex not-for-profit systems) to retain best practice, because they stop focussing on the learning and reflective practices which lead to innovation and development. Similar arguments have been put forward by other education scholars, notably Schon (1991) with his analysis of reflection-in-practice. The common thread of these approaches is the importance of making space for reflection and the consideration of novelty within the daily execution of the organisation's mandate. A culture of innovation is largely what has characterised the establishment of both Programs to date.

Edmondson identified four steps to enculturating 'execution-as-learning' into an organisation:

  • provide process guidelines;
  • provide tools that enable employees to collaborate in real time;
  • collect process data; and
  • institutionalise disciplined reflection. (Edmondson 2008:65-67)
One way for UDRHs and RCSs to retain their ability to be proactive in identifying and meeting the needs of the rural health workforce is to develop process guidelines which are clear protocols for high performance; support for collaboration; ongoing monitoring mechanisms; and structured opportunities to reflect and learn from their performance. All UDRHs and RCSs are already doing this to some extent, but it is admittedly a challenge to retain the cutting edge in the midst of demanding schedules, university and Program reporting requirements, and continual change and development in both staff and program activities. FRAME and ARHEN each contribute to their members' learning and reflective practices already by providing mechanisms and events in which members can share experiences and ideas, and develop new ways of thinking about common challenges.

An additional way in which the Department could encourage this quality approach would be to provide incentives for innovative exploration of new models for health service delivery. Creating a pool of innovation funding would provide an incentive for partnerships between academic entities but also could include local service providers and services. It would recognise the opportunity for the UDRHs and RCSs to become leaders in rural health service development and in doing so would advance both the workforce goals of the Programs and the teaching and research aspirations of the universities. The Department could structure the funding selection criteria in such a way that the applications reflect the kinds of partnerships and activities that are of particular relevance to the Australian Government's rural health workforce strategic aims.

Recommendation 11:

That the Department continue its current approach to the Programs, characterised by flexibility and openness to innovation.

Recommendation 12:

That the Department, in order to encourage collaboration and innovation, create a dedicated pool of funding which could be available on a competitive basis to RCSs, UDRHs and other university rural health institutions, for practical and applied health service delivery and workforce research and innovation.