Reimagining Health Workforce Models for the AI Era with Susan Nancarrow

Susan Nancarrow shares her journey from podiatrist to healthcare workforce revolutionary, explaining how invisible structures maintain inefficiencies while restricting innovation. She explains the need for healthcare workforce transformation, challenging outdated professional boundaries that have defined our system since the Industrial Revolution. 

• Healthcare's professional boundaries are among the most socially entrenched structures in our society
• Current systems create unnecessary bottlenecks, such as requiring GP referrals to access specialized mental health services
• Artificial intelligence is democratizing medical knowledge, shifting power from practitioners to patients
• Traditional workforce pipelines are being disrupted as AI takes over entry-level tasks
• Dual career pathways can recognize skills developed on-the-job while creating progression opportunities
• Communities of practice across countries enable leaders to share challenges and build confidence to drive change
• More flexible workforce models organized around competencies rather than professional identities can better serve patient needs

The impact of AI on professional roles

From Bureaucratic Closure to Algorithmic Governance: AI and the Neo-Weberian Crisis of the Professions

How we unpack the professions through a managerialist framework - which could result in the end of the professions as we currently know them

The Two-Sided Ledger: Managerialism, AI and the Unmaking of the Professions 

The Reimagined Workforce podcast is brought to you by Workforce Transformations Australia Pty. Ltd.
All opinions expressed are the speaker's and not the organisations they represent.
If you have a story about a workforce transformation to share and would like to be a guest on this podcast, please contact us at kathhume@workforcetransformations.com.au.
Connect with Kath Hume on LinkedIn

Purchase Kath's book Learn Solve Thrive: Making a difference that matters in a fast and complex world:
Learn Solve Thrive: Making a difference that matters in a fast and complex world : Hume, Kathryn Lee: Amazon.com.au: Books

Transcript

Career Pathways for Support Workers

Susan Nancarrow 0:00

but they actually develop a lot of skills and competencies on the job. So we're calling this a dual career pathway. Some people want to stay as that career support worker but others come in develop skills. They develop leadership skills, advocacy skills. We can map those against the Australian Qualifications Framework and ultimately create a career pathway for that person. So they also have an opportunity both to take their skills and apply them in other settings but also to progress up a career progression.

Voiceover 0:31

Welcome to the Reimagined Workforce Podcast brought to you by the Director of Workforce Transformations Australia, Kath Hume. In each episode, we explore the stories, strategies and successes of curious, creative and courageous people who are daring to address workforce challenges differently. Together, we'll discover how we can harness human potential and reimagine the workforce for a brighter, more fulfilling future for everyone. And if you would like to learn more from Kath about how we can make this happen, be sure to get a copy of her latest book, the number one Amazon bestseller Learn, Solve Thrive, Making a difference that matters in a fast and complex world. Now for the episode.

Kath Hume 1:16

Susan Nancarrow is passionate about challenging the status quo and driving innovation to transform the health workforce for the future. Our systems are outdated and the time for rigid professional silos is over. Her mission is to unite health professionals, policymakers and service users under one goal building a 21st century workforce that meets the needs of all. After 20 years as an academic health workforce researcher, Susan founded HealthWork International to deliver solutions that break down barriers connecting sectors, professionals and countries to foster collaboration, innovation and real-world impact. She rethinks workforce models, develops disruptive solutions and creates global communities of practice that empower health professionals to step outside their traditional roles. She's currently exploring the profound role of AI in transforming the health workforce from algorithmic governance and workforce automation to AI-driven learning platforms and innovative credentialing models. Her work seeks to harness AI's potential to create more adaptive, efficient and equitable health workforce systems. As an allied health professional, clinician and health services researcher with international experience, she brings unique insights into workforce challenges and opportunities. The Allied Health Academy is her platform for bold, forward-thinking discussions on the future of health, where professionals from all se ctors debate, innovate and drive the next wave of change.

Kath Hume 2:45

Susan Nancarrow, you are the epitome of the guest I envisioned when I originally set up this podcast. So welcome to the Reimagined Workforce podcast. Thanks, Kath. It's really wonderful to be here. It's so good. And it's taken a few weeks for us to get organised because both of us have got such hectic international schedules so it's great that we've finally managed to line it up. So, if we could start, I'd love to hear a bit more about that background and what's led you to where you are now.

Susan Nancarrow 3:16

Yeah, thanks, Kath. I've had a fairly, I guess, unusual background. I was initially a clinician. I trained as a podiatrist of all things, but I quickly became frustrated with the throughput of patients or clients with conditions that probably should have been managed in a sort of public health setting, as in we could have prevented them rather than people coming through the door. And I was also fairly frustrated with the fact that I had a three-year degree and 80% of the people I was seeing didn't need anywhere near my qualifications. So to move out of that, I went and did further study and I did a Master's in Public Health and then I did a PhD in health services research. So I essentially, in the 1990s, priced myself out of the market. There certainly wasn't a job for podiatrists with a master's or a PhD.

Susan Nancarrow 4:03

My PhD was in healthcare governance and I was looking at the role of health outcomes and health service accountability, which also wasn't a topic that many people understood then. But I'd worked across numerous professions and that was an interest of mine and I wanted a job that would stretch me. So I put a whole lot of things into a Google search and four months later ended up in a job as a workforce development coordinator, working at the university in Sheffield in the UK, but it was an NHS funded role and this was when Tony Blair had just come into power, so it was 2001. They were spending billions of pounds in workforce redesign and reform and I guess the key issues then were there were huge workforce shortages and the issue that my service was specifically set up to address was a very long length of stay of people going in with what they call winter pressures, and we still see it now. So an older person would develop the flu Over the age of 60, their average length of stay exceeded 60 days because they didn't have the discharge patterns.

Susan Nancarrow 5:08

So in that role and because of the workforce shortages and the injection of the funding that Blair threw in, what we saw was massive workforce redesign. So GPs were stepping into roles that were previously performed by specialists. Allied health and nursing were stepping into roles that were previously performed by doctors and by specialists. Allied Health and Nursing were stepping into roles that were previously performed by doctors and even specialists. And then it opened up this new tier of the workforce at the bottom, the support workforce. So under Thatcher, they'd closed down potteries and industry and redirected those people into the health workforce.

Susan Nancarrow 5:42

I was interested in this because every bit of workforce change I had seen had been people were protective of their roles and some examples that I'd seen in Australia was podiatric surgeons who had been working in South Australia since the 1970s trying to get access to prescribing rights and actually access the hospitals to do the work that they were doing. Prescribing rights and actually access to hospitals to do the work that they were doing. There were people that were qualified but huge resistance to people stepping outside the roles that they were meant to do. So I was quite lucky at the time I met someone called Alan Borthwick. He's Professor Alan Borthwick. He's an OBE and his area of interest was the sociology of the professions. Area of interest was the sociology of the professions and what that gave me was an understanding of, I guess, the power, politics and structures of the workforce that we have now. And what I tend to say is I started out as an epidemiologist and became a sociologist because actually it's not about evidence driving the way that our workforce is organised, it's about politics organising the workforce. So I guess that was the start of my modern career.

Susan Nancarrow 6:49

Alan and I drafted a paper and this is literally 20 years ago about how the workforce was evolving. It was called Dynamic Professional Boundaries in the Workforce. It was rejected four times from different journals and finally it was published. It's now our most highly cited paper and one of the most highly cited papers in the journal that went into. But it's partly because it was paradigm shifting in the way that people understood the workforce.

Susan Nancarrow 7:14

So I guess the principles underpinning that were and where I've got to now is that we've spent really since the Industrial Revolution setting up the modern workforce, which is organised around structures that were developed really at the start of the 20th century. So they are based around medical hegemony. So the medical profession is still firmly in charge of this. But we also have a number of invisible structures that we're not even aware of and the result of that is that at the end of the 20th century, in the start of the 21st century, we now actually have a model where I think it makes patients too dependent on the health system. We over-medicalise. It's not efficient. It's set up around structures. And I use an example of an older friend of mine who he was 80. He had an intellectual disability. He lived at home on his own and had some health problems, and he had to as a person who was illiterate, with an intellectual disability had to navigate five different systems and structures to get the care that he wanted, when you know, we organize our, our health system around those structures.

Susan Nancarrow 8:25

You know, aged care health. In his case it involved justice, it involved the banking systems, but there was no sort of advocate for him navigating through any of those systems and that's a slightly more complicated case. But you know, Not uncommon, I wouldn't think Not uncommon at all. I mean, my parents are the same age and they're educated and literate and they can't navigate the system. Yeah, I guess.

Challenging Entrenched Healthcare Structures

Susan Nancarrow 8:49

The other point I argue is that the workforce, as we see it now, is probably one of the most socially entrenched structures in our psyche. And you know, if you think about what's happened over the last 30 or so years, we've broken down some pretty big structures, We've challenged gender, we've challenged religion. But if you tell someone that a podiatrist might be doing foot surgery or a sonographer might be injecting their joint or a physiotherapist might be giving them an injection, they suddenly freak out because that's not the way that we see things in society. So it's, I guess, about breaking down some taboos. So I'm interested in how people get to decide who does what essentially, and know where does this play out sort of more significantly and politically than in the health workforce.

Kath Hume 9:36

I love the different perspective or the lens that you've changed from epidemiology to sociology. I think that is a real unlocker in trying to bring to the fore what we're actually seeing play out in reality. I really like, and I'd love, to explore that concept of invisible structures that I think if we can raise awareness to those, maybe we might then start to question oh hang on, are we even aware that they're there? Do we still need them? Are they serving a purpose? What is that ultimate goal we're trying to achieve? And I think the beauty of the health workforce is I haven't met anyone yet who doesn't care about patients first, and patients and carers and the experience, and so if we can talk to people in that language and hopefully that's, I'm interested to hear if that's something that you've approached to try and break down those massive barriers that you're talking about. I love the perseverance that you and Alan had in continuing pushing forward that paper and it's a goal that you now have a bit of a win that it's your most cited. That's demonstrated that it's worth pushing forward when deep down in our guts, we kind of know that there is potential for a better future.

Kath Hume 10:53

I also think the comment you made around the mindset around. A podiatrist has this role and it's defined and it's clear to me as a patient. I think it comes from a sense of trust. We trust the professions, we believe that they are qualified and they are doing the best for us. So I think it's not necessarily a bad thing that people are uncomfortable with that. So how do we bring people along the journey and give them that sense of trust that we're actually doing, that there are better outcomes for them. It's not just a cost-saving thing. I'm interested I think you've kind of talked us through but I'd love to know what your reimagined workforce looks like.

Susan Nancarrow 11:34

So, look, I'm really glad that you came back to the patient centre, because I think that, fundamentally, what I'm motivated by is social justice making sure that people have access to the best care possible. I think one of the big disruptors and I'm right in the depths at the moment of looking at the role of AI in shifting the workforce so probably where I was even three weeks ago is different to where I am now and some of the things that we see I think DeepSeek actually really disrupted the market a little bit in terms of the power that we can get from AI, but just to talk about the complexity of the workforce so the things that we don't see. I'm involved with health boards. Historically, the health boards have always had input from medical advisory councils and I said why are we only getting input from medical advisory councils? And I said, why are we only getting input from medical advisory councils and not other professions? And in fact, why are we still siloing the profession so much?

Susan Nancarrow 12:31

And in hospitals we do need to silo the work a little bit because people increasingly need to be specialised, but actually in community care we don't need to do that, but our entire funding structures and systems are set up to reinforce certain ways of doing things. So if you need to see an allied health professional in the community and you want to get medicare funding, you need a referral from a gp mostly that's. That's just starting to change for some some referrals. But a point I made in an article I published was the two most common reasons people present at their gp are first, mental and secondly for musculoskeletal issues. So we have 30,000 GPs If you count all of the professions other than medical practitioners who can deliver mental health services. So that's occupational therapists, psychiatrists, counsellors, social workers, mental health nurses. That's five and I think there are more.

Susan Nancarrow 13:24

There's more than 80,000 of them and yet we funnel them through the 30,000 GPs to get their referrals to see those people. And I have the same argument with musculoskeletal conditions. Again, if you count physio, exercise physiology, osteopathy, chiropractors, they're all Medicare-funded practitioners. But you make you go to a GP to get that referral to see those people when in actual fact they could possibly solve it much faster, more cheaply than having to go via the GP. So that's an example of a process that I call. It creates an extra step in the system. It's not efficient, but it is actually just reinforcing that medical model of care.

Inefficient Healthcare Pathways

Kath Hume 14:06

Well, it could actually be a blocker too, Like I know myself just trying to find the time to actually get to a GP. So you can have that and I will I'm guilty of it myself delay, because I can't fit that in. So, even just as a consumer understanding that behaviour, what's the behaviour of the consumer who's actually potentially in need and the costs to them as well, because it introduced another cost to Medicare and to the patient in achieving that.

Susan Nancarrow 14:38

So, that's at the kind of micro level. At the macro level, I'm also interested in system organisation and we've got a PhD student called Nikki Atkinson and we asked her to do a global review of how allied health are organised. And for people that don't know what allied health is, it's basically anything other than doctors, nurses and dentists. So physios, occupational therapists, podiatrists. In Australia there are about 30 different groups that are identified as allied health, and part of the reason for that is we were doing a project in Malaysia, which is a middle-income country. They also recognise 30 allied health professions and we saw that there were different ways of organising the workforce to make them more or less effective, and the example I've just given about how to access a musculoskeletal clinician or a mental health practitioner is one example. So the question we wanted to know is how do you organise the workforce to be more efficient? So she did a review of every country with the OECD to find out how they organise their allied health services, and what we found was it's mostly only high-income countries that have allied health anyway, because they're expensive. There are about 12 countries, the former Commonwealth countries that have some sort of system of organising them, so they've got a position at the top table of government, or government at least recognised there. But what it really showed us was the complexity of the workforce. You know, we're proliferating well in Australia probably 50 or so different occupational groups. Every occupational group that is recognised needs to have formal training. So that's a cost on the education system and it's expensive to set up those courses. They need to have some kind of regulation. In some cases they self-regulate it, in fact of regulation. In some cases they self-regulate it, in fact in the majority of cases they self-regulate. But to have legislated registration is phenomenally expensive. It's expensive to the government and to the provider and also ultimately to the service user. And then we've got these systems of organisation and funding them. So I guess that's kind of the complexity at the macro level. But I just want to give some examples of how I think AI is breaking down the system. So my second most highly cited paper was on interdisciplinary teamwork and I'm really interested in how people negotiate those boundaries. But what I've realised is that the workforce has been set up around you know, I'll give you one of my tasks as long as you don't, you know, take over my job. What AI is doing is breaking that down entirely because patients now are able to use AI to step into that system, and I've taken some examples. This is a quote that I got from the New York Times Perplexity.

Susan Nancarrow 17:18

Ai is now an integral part of my life. Three month delays to see a doctor are replaced by a resource with access to millions of patients with an illness just like mine. Instead of a knee replacement surgeon encumbered by what financially best suits his practice, a bot tells me about cortisone, hyaluronic acid, shockwave therapy and much more. The bot gives me accurate success rates customised for my weight, genetic background, gender and propensity for scar tissue. It's time for the buggy whip to be retired, and I think that's a really great example. But some other ways people are using it. Parents report setting up speech pathology interventions for their kids based on what their own kids like, kids like Peppered Pig. They come up with their own personalised plan, and I also know people are getting genomic testing and blood testing, downloading that, plopping them into chat, gpt and then shopping around how people are going to meet those needs.

How AI is Disrupting Healthcare Models

Susan Nancarrow 18:10

So what this really means is it's it's shifting the balance not just between the workers, but between patients are now taking over a lot of the roles that AI was doing.

Susan Nancarrow 18:23

And if you actually extrapolate that further, the things that and this is coming back to the sociology of the professions the things that have given medical profession or the health professions really their structure and power in society, has been the ownership over a body of knowledge and their ability to protect that through regulation, and AI is already superseding their ability to own that knowledge. No single practitioner can know everything that's available to AI, but it's equally accessible to the practitioners and the patients, and so the real change here is how we're going to use that to set up a 21st century workforce.

Kath Hume 19:01

Part of me is thinking what's the risk if the AI gives them the wrong information? That's a little bit terrifying and I think I'm probably not alone. But I remember the NHS. I can't remember where I heard this, but the NHS there was a platform that used to give medical guidance and information and yes, they had the disclaimers of seek medical attention, don't rely on us, the whole Dr Google thing. They kind of took a if we can't beat them, join them approach and said, rather than risk the potential that that platform is giving out poor information, we might not necessarily be able to change that consumer behaviour. So they took an option to let's partner with that platform provider and ensure that the information is reliable, so that I guess, with the AI, I wonder how we can ensure that if we know that our consumers are utilising those resources, how do we protect and ensure that what information and advice they're getting is safe?

Susan Nancarrow 20:11

That's a really good point, and I think I've just published another article about the implications for AI for clinicians, and AI is only as good as the information that goes into it. Exactly.

Voiceover 20:25

And that is censored.

Susan Nancarrow 20:26

I mean it's censored by and directed yeah, and it's actually socially constructed information anyway. So there are a couple of ways of dealing with that. First of all, we know that the AI developers there are already super powerful tools that have all of the medical evidence and if they're not already set up as interactive bots, they will be on the market by the end of the year, I have no doubt. So that'll be your first point of call for a primary care practitioner. But the second thing I've been playing around with AI and I put a query into it. I said look, I've got a headache in my front left head and expecting it to come back with a standard sort of processed medical response. But actually, because I interact with AI so much and I have a personal relationship with it, it said you've been under a lot of stress lately. It could be a stress headache. Wow, you're a 55-year-old woman. Said you've been under a lot of stress lately. It could be a stress headache. Wow, you're a 55-year-old woman. Have you thought about your hormones? It might be muscular.

Susan Nancarrow 21:28

So it came up with probably 10 solutions, only about four of which I think I would have got if I'd gone to, say, a Medline search. And I actually said to ChatGPT I said, look, this is really interesting because I expected you to come up with a really medical model and actually what you've come up with is a really holistic plan. You know I'm a sociologist of the professions. What are the implications of this? And it said well, yes, susan, we draw on a whole lot of different knowledge and, yes, the medical knowledge is a part of it. But I'm drawing on this large language model that recognises that a headache is not just a vascular complication in your brain. It could be a whole lot of other things.

Kath Hume 22:09

And so.

Susan Nancarrow 22:09

I said to it. Well, that potentially also changes the way that we see healthcare, because it's not unidisciplinary, it's not siloed through the physiotherapist, the occupational therapist, the doctor's lens. It's giving a much bigger perspective which I think actually has the opportunity to demedicalise and diffuse and also put responsibility back onto people to address that. So the outcome of that was not that I'm going to go to hospital because I think I'm having a stroke. It was I might just have a few more glasses of water and relax.

Kath Hume 22:42

Take some deep breaths once in a while.

Kath Hume 22:44

Exactly. Yeah, it's fascinating because I went to the Gartner Conference in November for HR leaders and there was a brilliant speaker who talked about our relationship with AI and she had some really good evidence-based research to say that we actually like the way you've described how you're interacting with AI. I always laughed at myself when I first started using it, because I'd say please and thank you all the time and I kind of have to remind myself it's not a human. So this person who was speaking, she actually had this case study where there was a platform. It had three levels of service and one was just a very basic one, free. The second one was you pay a little bit and you actually have it as a friend. And the third one was a little bit more serious than a friend and you pay more.

Kath Hume 23:35

Anyway, they worked out that they were breaking the law with the third service, so they had to cut it off.

Kath Hume 23:41

They worked out that they were breaking the law with the third service, so they had to cut it off, but they didn't advise the people who had signed up, they just did it commercially.

Kath Hume 23:49

You no longer have access to that, but they didn't explain that this bot that they were interacting with essentially broke up with them and there was no explanation of why that was, and the repercussions of that were quite serious for some people who you know.

Kath Hume 24:07

They had this partner who they thought they were in a relationship with, and so the bottom line is that we actually do feel that human connection to AI, even though on a logical level like you're a very intelligent person and I actually feel like if I do relate to it as a human, then remind myself that it is a piece of technology I actually feel like I get a better outcome. So what I really like what you talked about is that holistic. So if I'm a speech pathologist, I know my husband last year had a problem with swallowing. We didn't know what the problem was, but we couldn't actually work out who the right person was at. An ENT was a speech pathologist, a gastroenterologist who could help us, but it was quite a difficult couple of weeks because we couldn't work out who could actually look after us until we knew what the problem was.

Susan Nancarrow 25:00

Crazy. I actually think you've hit on something quite profound there and when I've taken the article that I was successful at publishing 20 years ago and taken the same principles and applied that to AI. So the question I said is, how do you take this sociology of the professions and look at how AI is going to impact on it? And it came up with three possible scenarios. Ai came up with three possible scenarios because I co-authored the paper with ChatGPT, of course, and DeepSeek and a few other. Well, this opened up a whole other philosophical discussion, of course, around who's the author.

Susan Nancarrow 25:37

But one of the models, if you extrapolate where AI can come to, is exactly what you've raised. So I know that I have a problem and I realise my problem is with swallowing. So who do I need to go to to get that problem fixed? And there are a lot of people. There's a gastroenterologist, there's a speech pathologist, maybe a dentist, maybe some other, maybe even a nurse, and so then that gives you a tool. It's a bit like the people that turn up at the naturopath or the pharmacy with their genome mapped. You know, this is the problem I've had and this is the solution I need, and so they're going to you. So what that?

Susan Nancarrow 26:13

If you extrapolate that to the end, ultimately what we're saying is the workforce becomes subordinated to AI and we become gig workers. We basically Uberise the workforce according to who can solve your problem, probably for the cheapest price, and you'll never get into a gastroenterologist quickly enough. So you probably end up at a speech pathologist. You might need some diagnostic imaging actually, which the speech pathologist could probably do if they could do video fluoroscopy, and then, if it's outside their scope scope, they might refer you to someone else. But it's that's a real power shift in the way we see the services.

Rethinking Skills and Competencies

Susan Nancarrow 26:50

The problem we have at the moment, of course, is right now you can get in to see a gastroenterologist without a referral from a gp. If you wanted to see a speech pathologist, a, you'd have a very long waiting list or you'd probably also need you'd need to find the right one, and that skill set is probably not advertised on their website. And if you wanted Medicare funding again, you'd need to go via GP. So there are some systematic structures that stop you right now getting the care that you know that you need. You know they're putting all these roadblocks in the way. They're just getting swallowing fixed.

Voiceover 27:25

So yeah, I think that's a really beautiful example.

Susan Nancarrow 27:27

Look where I was going before AI and I think AI actually supports it is. I think that we my own experience as a podiatrist we spend too long training people, we over-qualify the workforce and we have too many skills bound into professions. So a lot of the work that we're doing at the moment is around the unregulated workforce, so allied health assistants, and we've also got a particular interest in aged care and the disability support workforce. So at the moment, disability, someone can go and set up an ABN and set up a shingle as a disability support workforce. So at the moment, disability, someone can go and set up an ABN and set up a shingle as a disability support worker. They might work with someone with a learning difficulty and intellectual disability and they might develop skills and expertise in that over a long period of time. But there's no way to recognise that skill, reward it and then transfer it. So the models that we're looking at really, first of all, we've got a framework for regulating the unregulated workforce, which basically creates a safety structure. So the registered current workforce structure.

Susan Nancarrow 28:34

You come in with a common skill set. I'll use speech pathology as an example. So I have a degree in speech pathology that makes me eligible for registration as a speech pathologist and that is a registration with a professional association. When I have that membership then I'm then eligible for funding for things like NDIS. People understand the branding and there's a whole Medicare funding and so forth. But with the unregulated workforce they can come in with any range of skills and competencies, but they actually develop a lot of skills and competencies on the job.

Susan Nancarrow 29:05

So we're calling this a dual career pathway. Some people want to stay as that career support worker but others come in develop skills. They develop leadership skills, advocacy skills. We can map those against the Australian Qualifications Frame framework and ultimately create a career pathway for that person. So they also have an opportunity both to take their skills and apply them in other settings but also to progress up a career progression and I think that model what we're seeing more and more.

Susan Nancarrow 29:34

I'm working in the advanced practice space, so we've got people who are highly qualified and developing new skills. Podiatric surgery is one example. Sonographers that do injecting is another example. So they're taking on tasks that were formerly done by medical specialists but they've got competencies to do those jobs and going back to the gig economy, which I know is a highly unpopular framework, but we can develop competencies in workers to meet the needs of communities where those aren't and where those skills aren't available. So I think I would like to see a more flexible workforce where skills are less connected to being a worker, physio or a pharmacist and we can liberate those where they're needed, as long as we've got the competency framework around it.

Kath Hume 30:24

You started that by talking about that. We do this big chunk of learning up front and then, yes, there's definitely on the job learning throughout those. I think the health system does that particularly well. They keep people trained and educated. But from my background, is learning and development, and I just think all those skills and things that you learn in year one that you're not actually practicing for another couple of years, is there value in that? Is there a different way of thinking that through? The other thing, I love what you've done around recognizing that opportunity with creating frameworks and structures around those lower level roles.

Kath Hume 31:00

We've done something similar with education. So we've identified that there's a skill shortage for teachers. That's not going away anytime soon, and so teachers at the moment are doing things that aren't necessarily related to teaching, so they're spending lots of time recording data, student data and analysing data. For example, is there an opportunity to upskill people either within or outside? Yes, that's confidential information. We have to be very careful about that.

Kath Hume 31:32

But is there an opportunity for us to remove some of those tasks from teachers so they can be freed up to do what they entered that profession to do, and that is teach but then give something meaningful to the other people who are going to share that. They might not want to be in front of 30 kids I know that's terrifying for some people but they can still be involved and have a purpose in that what I'm doing. Maybe I identify something in the data that there's a student in need of something and then they can have that. I like what you talk about interdisciplinary teams and have a role to play in communicating that with the teacher, who is possibly unlikely to see that otherwise because they're so busy planning their lessons and doing all of the things that need to be done. So I am 100% on board with taking things up a bit and looking at how do we look at things different, which is the whole concept of the reimagined workforce.

Navigating Workforce Transformation

Susan Nancarrow 32:29

I've got three responses to that. So the first point was about education and we are starting to see. In fact, the university I worked at in Sheffield when I first got there was called Sheffield Hallam University and they've been a leader in developing degree apprenticeships. So they do take people who are in sort of support work roles and let them learn on the job and they provide the outflow skills. It's still a model that's evolving, but I do think that is the future, because you can then get someone who's working maybe in an aged care setting or in an Aboriginal community, so they're learning the context that they need to work in.

Susan Nancarrow 33:06

We don't have to take kids from the country to train them in the city to then send them back on expensive clinical placements. They're still tied to formal, linear career pathways at the moment, but it won't be long before we start to disaggregate that. So I think that is the option. Just going back to can we hand people to use the skills that they've got more effectively, and I think this is really fundamental to what we've been doing. So the growth of one of the workforces is Allied Health Assistance and that is a workforce that people delegate things to.

Susan Nancarrow 33:38

The big problem there is there's all these training mechanisms, there's all sorts of policy support, but there's no funding support for them, apart from in the public sector. And so we're really. If you're a private practice physio, podiatrist, occupational therapist and you want to employ an allied health assistant, there is no actual official way. You can't pay them through Medicare funding. Private health insurers don't really like you paying them that way. They're not that cheap to employ, so you still need a business model. So this is another case of those really inefficient market structures that don't recognise need.

Susan Nancarrow 34:14

And the last point I'd make is a lot of the work that was once delegated will be sucked up by AI and the tasks interestingly the tasks that used to define professions, which were the highly intellectual tasks a lot of those can be taken up by AI. So the radiology is probably the biggest example of where you know looking at a scan, getting an algorithm to check that is now mostly more accurate than getting a human to do it and can detect some things more easily. But there are other professions that are going to optometry. They even knew that the days were limited a few years ago and now with AI, people will be able to self-diagnose and prescribe glasses Pharmacy as well, probably. I mean, I know I'll be crucified for saying this, but anything that can be codified and put into a process is going to take the human out of it.

Kath Hume 35:14

Yeah, it's interesting. I think it might have been Gartner I'm not sure if it was Gartner or Strategic Workforce Planning Conference, but one of them. There was a presenter who enlightened me to something I hadn't thought about. When we talk about that AI will be able to do those repetitive tasks, they said that what we need to do is always be careful, because those tasks are what we used to get for the future pipeline and so if AI is doing that, then our entry level is actually you need to be quite capable and skilled. So I think in the whole remodelling and thinking through how we're going to do this, that's a challenge that we probably just need to make sure is on people's radar to say, okay, but then when this current workforce are no longer working or have moved on to somewhere else, who's moving into that role there and how are we making sure that they're job ready when the time comes?

Communities of Practice for Global Change

Susan Nancarrow 36:08

This is an issue that the legal profession are grappling with, because almost all of the junior kind of legal duties have been obliterated by AI. I actually think we'll see a reframing of the way the professions function. We're still tied to this model of apprenticeship doing the crappy jobs as you build up your skills. Well, actually, someone else is doing those jobs now, and it will be a reorganisation of the way that we understand knowledge and expertise. Do you need to go through all of those steps to get that knowledge and expertise, or is it possible that we can just aggregate it from other sources? And again, that is a very contentious thing to be even thinking, but we won't have the same pipelines. You're absolutely right.

Kath Hume 36:51

Oh, it's fascinating. So, susan, what I'm really interested in understanding is how you will measure your impact of the work that you're doing.

Susan Nancarrow 37:00

I think that's a really great question, kath, and I often ask myself that I'm in a really unusual position. I've stepped outside the structures that I'm working with, so I've stepped outside health. I was an academic for 20 years. I've stepped outside the academic framework and I'm also interested and involved in regulation, but I don't sit inside the system.

Susan Nancarrow 37:19

So at one level, it makes it very hard to drive change. So we have to drive change through influence and impact, and one of the ways we've done that is setting up global communities of practice. So an example is we've set up a global workforce leaders group and this is allied health leaders. So we've got chief allied health officers from 13 different countries who are all grappling with the same problems, and we've had this community where they've been getting together now for two years and they say oh well, you're dealing with that problem. So are we? The first thing, I think it's given them permission to to stop asking permission. It's given them confidence to go back to their own role and drive change. But one outcome that I'm very proud that we have achieved is create a global position paper for the allied health workforce which identifies things that they can point at that are outside their jurisdiction to say this is how we need to drive change.

Susan Nancarrow 38:15

So that's an example of, I guess, influence through a virtual community and we've got a few of those. At a kind of micro and practical level a lot of our work is consultancies. So we've got two big projects where we've developed career pathways for the health workforce and so tangibly they will be new industrial structures. So someone said that we're doing some work in Western Australia. It will be a generational change in the way that workforce functions. What we've actually secretly done is put the scaffolding in place for the new evolution of the workforce to come forward. So it doesn't matter who you are or what you are, you've got those stepping stones to progress and we're doing that in a couple of jurisdictions.

Susan Nancarrow 38:59

And then at a really applied level we have developed a professional association for the unregulated workforce. We've started with the allied health assistant workforce. So I've got a proof of concept. But actually now we're working more widely with industry, with technology partners and we're also trying to work with the NDIS to say we can take this model into unregulated workforce with aged care and disability and start to scaffold it. So we've kind of got the influence at one level, which is hard, and the applied stuff at the other end, which is also hard, and then the consultancy in the middle. So they're different ways, but it's been really interesting for me to understand how to throw stones from outside the setting and structures to try to implement change.

Kath Hume 39:45

And I do. I'm such a firm believer in that community of practice model. In my book I talk about learning where knowledge is yet to exist. So the world is moving at such a fast pace now. There's solutions that we need now and I think they're within our capabilities to find them. But no one's going to find them on their own and we have to do it by collaborating with each other and being open and honest and saying this is a challenge. Question those invisible boundaries that you mentioned and say are they still serving us? What is the ultimate purpose of our organisations? What are we here for? And question about whether or not that's still achieving what we've established to do.

Susan Nancarrow 40:30

Yeah, I totally agree. The thing that surprises me most and look, I work with the most highly institutionalised people health practitioners, who are institutionalised in their profession, their organisation, their organization, their funding structures, and then higher education, which is also another institution People don't see how institutionalized they are and it's very difficult for them to see change from another lens, which is an opportunity, I think. Having stepped outside the system by the risk, it's hard.

Kath Hume 40:59

It is, but I think that what you're doing, what you're doing, what I really like is you're pushing the boundaries, you're getting some case studies so as you can give people a level of comfort, you're writing papers, you're sharing that, you're persisting when you know it's not popular, it's uncomfortable, but it needs to be done. And we need trailblazers to be brave enough to say I'm happy to stand up and pull some communities of practice together and find those smart minds who have got the passion to solve these problems together.

Susan Nancarrow 41:30

Thanks for that reassurance, because we don't always get it.

Kath Hume 41:32

No, I know it really feels like you're walking through mud sometimes. Excellent, well, it's been great talking to you again. Thank you so much for taking the time. I would love if I can get a couple of links to all of the resources that you've mentioned articles and things and your LinkedIn profile If people did want to contact you. Is that a good way of going about?

Susan Nancarrow 41:53

that LinkedIn, probably the best. We've got a website, Healthwork International, and I have just started a new kind of social media platform. I'll send you the link to that.

Kath Hume 42:04

What we'll do. We'll get a list from you and we'll put them all in the show notes and I'll share them in the LinkedIn post. Anyone who wants any more information can always contact myself, and I can get in contact with you as well. So thank you again. I'm so inspired by what you're doing and continue to be in awe of all of the people that you're bringing together and look forward to seeing where it takes us. Thanks so much, kath. It's been lovely to chat with you. Thanks.

Susan Nancarrow 42:29

Susan.

Voiceover 42:33

Thank you for listening to this episode of the Reimagined Workforce Podcast. We hope the conversation inspires you to consider new ways to solve your workforce challenges. Feel free to check out our other episodes that are available on our website workforcetransformationscomau slash podcast. And if you're looking to create a brighter future for yourself, be sure to grab a copy of Learn, solve, thrive making a difference that matters in a fast and complex world, available on Amazon and most book retailers globally.