Welcome to the latest edition of the 2024 On the Horizon newsletter from the Future Workforce Unit (FWU). On the Horizon provides a snapshot of the key trends and developments that have the potential to shape and impact our future workforce, workplace and ways of working.

On the Horizon is part of the Focus on the Future Workforce Initiative, which aims to support the health system to ensure a resilient and digitally enabled workforce that can adapt to the changes in the system caused by technology and other disruptions. By focusing on not just the now, but also the future, NSW Health can ensure that we meet the needs of the community now and into the future.

Please note that the opinions shared in On the Horizon are those of the respective authors, and may not reflect the views of FWU or NSW Health.

Aboriginal & Torres Strait Islander readers are advised that the articles may contain images of people who have passed away.

Back in the 1980s, the US Army War College introduced the concept of VUCA, which stands for Volatility, Uncertainty, Complexity, and Ambiguity. It’s basically a fancy way of saying that the business world is more unpredictable and complicated than ever before. In many a LinkedIn post you’ll see a call to action like this... to do well in this unpredictable world, businesses need to be smart, quick to adapt, and ready for anything.

In this month's edition of On the Horizon, we're exploring a range of signals including the use of artificial intelligence (AI) in identifying social determinants of health in patients, the potential of digital twin technology in healthcare and public health, and the effects of climate change on the health workforce.

Through On the Horizon we aim to offer a perspective that involves signals of the present, and their potential on the future. While we can't predict exactly, or even forecast what will happen tomorrow, it is possible to imagine what might happen and prepare for the possibilities. I invite you, as you sift through these trends, to use the questions included to prompt further conversations with your peers and networks to explore what these trends could mean for your future context. We know that not one person or idea in isolation will be a part of a solution, but entire ecosystems working together to realise true transformative change.

Finally, we are excited to report that the countdown is on for the launch of Series 5 of the Future Health Podcast in May. This season, our podcast has a new look and feel. Watch this space, and we will share with you the thought-provoking content of season 5! You can subscribe at your preferred listening platform (details provided below).

- Tamara Lee 

Director, Future Workforce

The social determinants of health (SDoH) are defined by the World Health Organisation as “the conditions in which people are born, grow, live, work, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies, and political systems.”

In healthcare, it can be difficult to reach those we do not see until they arrive in crisis at our emergency departments. There are many successful projects and programs across NSW Health that reach such individuals, and show how efforts have tackled issues related to social factors influencing health. And with advancements in technology and data analysis, there may be another approach on the horizon.

A new study published in npj Digital Medicine journal has found that large language models (LLMs), a type of generative artificial intelligence (AI), can be trained to automatically extract information on SDoH from clinicians’ notes which could enhance efforts to identify patients who may benefit from resource support. The research reports that the adjusted LLMs could identify 93.8% of patients with adverse SDoH and was less prone to bias than other superseded models.

Collecting and understanding SDoH information offers significant potential and can uncover important contextual information about patients’ lifestyles to supplement clinical findings and allow for early intervention. Whilst more research and fine tuning of LLMs is still needed, it is possible to imagine the opportunities of working with technology that compliments human capital in similar ways. So, how can we best prepare to work in an ecosystem like this? What other ways could similar technology complement our workforce to enhance patient care and the social determinants of health?

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The use of digital twins has proliferated across multiple sectors and industries, with a notable surge in the healthcare sector. The application of digital twins are said to have the potential to revolutionise the entire health care system.

In the context of healthcare, a digital twin represents a virtual model of a patient, medical device, or even an entire healthcare facility. These digital twins simulate real-world conditions to monitor, analyse, and optimise performance in a virtual environment. Digital twins are created by integrating data from various sources, including electronic health records, wearable devices, IoT sensors and administrative systems. By leveraging this data, healthcare professionals and organisations can use digital twin technology for early detection of health risks and proactive interventions, optimising workflows and resource allocation, and facilitating training and simulation opportunities to enhance clinician’s skills and patient safety. For the healthcare workforce, digital twins serve as decision support tools, enabling clinicians to test hypotheses and explore treatment options in a risk-free environment, and collaborate in real-time. Public health researchers are also developing digital replicas of real communities using anonymised electronic health records, including biological, social and geographic data, to analyse health trends and disparities between neighbouring communities.

Developed by eHealth, the NSW Health Enterprise Data Lake (EDL) has been designed to make analysing data more efficient for NSW Health organisations by facilitating the development of data extracts in near real-time. The technical solution also presents a significant breakthrough for data science, machine learning, artificial intelligence and big data analytics. An EDL isn't a digital twin itself but can be a feeder system for any digital twin technology. Given that EDL is our one source for all organisational data, it can complement digital twin technology if set up within NSW Health.

Looking ahead, how could digital twin technology support the work that you do or the work of your organisation? How might digital twins reshape workforce dynamics and professional development in healthcare? How could digital twin technology make future health service delivery safer?

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Climate change is one of the most pressing challenges of the 21st century. From heatwaves to bushfires, the manifestations of climate change are becoming increasingly evident across Australia and the world, reshaping landscapes and communities alike. Climate change is already significantly affecting human health and as the impacts continue, health systems will need to grapple with increasing numbers of hospital presentations related to climate events such as extreme temperatures.

The impacts of climate change and climate events on health systems and on workforces are immediate but are also sustained as systems and workforces recover. Additionally, when climate events ‘collide’, and their impacts compound, recovery becomes even more challenging. This period is often associated with significant risk of workforce attrition, especially when those involved in crises are not appropriately supported.

According to a study from The Australian National University, impacts such as extreme heat could lead to health workforce shortages in rural and remote communities, which already struggle to attract and keep doctors. The report found that one Australian Jurisdiction could lose up to a third of its doctors as they look to escape the dangerous effects of climate change.

A commitment and vision has been set for NSW Health to achieve a climate resilient health system, and significant work has already started in the space, but as you reflect, what skills and support might the future health workforce require to be able to meet the healthcare demands of climate change? How can we best prepare future health professionals to navigate the complex intersection of climate change, public health, and emergency response? In the wake of climate-related disasters, how could other approaches such as policies that build resilience, and new partnerships between sectors that have not traditionally collaborated help mitigate future risks to the health workforce and public health?

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Future Health is a podcast from NSW Health about the future ways we will work, the work we will do and the impact of technology and scientific innovation on the future of healthcare. We are working towards an impactful new season; Dr Louise Messara is joined by a fantastic line-up of guests to discuss the future of work in healthcare, exploring topics around the theme of “What if…”.

Each episode will increase the listeners exposure to the research, analysis and insights, generated locally and from across the world, that will challenge us to consider where we are and where we could be going. The narrative-based, relatable content will resonate with the curious listener looking to learn from others and be inspired and open-minded in a fast-changing world.

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While every effort is taken to validate the currency and accuracy of the content presented in the newsletter, NSW Health does not make any representations and  warranties with respect to the accuracy and completeness of the information contained herein. The content is represented as information only and readers should undertake their own research and enquires with respect to the specific details and information contained in this newsletter.

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