S9 EP2: Stefano Scalzo, Government Goodies

Stefano discusses the importance of stakeholder engagement and planning for one of the largest Health Portfolios in Australia.

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Transcript

[00:00:00] David Cummins: G'day and welcome to the Australian Health Design Council podcast series, Health Design on the Go. I'm your host, David Cummins, and today we're speaking to Stefano Scalzo, who is the Executive General Manager of Infrastructure Planning within Infrastructure Division of the Victorian Department of Health.

[00:00:32] Graduating as an architect in the early 90s, Stefano soon became the Principal at Lyons Architecture and then followed his calling into public health, where he has climbed the ranks to become the Executive General Manager we know today. 

[00:00:45] Stefano has a phenomenal education history, including winning the prestigious 50th year anniversary Churchill Followship in 2015, which allowed him to travel across Europe, studying mental health, allowing his findings to be published in the Churchill Trust, the Australian Health Infrastructure Alliance and the Australian Design Community.

[00:01:03] I'm excited to learn more about Stefano today and hear more about what the Department of Health is doing in Victoria now and into the future. 

[00:01:09] Welcome, Stefano. Thank you for your time to be here. 

[00:01:11] Stefano Scalzo: Thanks, David and happy to be here mate. 

[00:01:14] David Cummins: The thing I like about you is that you continue to study and you continue to put a lot of LinkedIn posts about study, interest in research, facts and figures, which you generally don't see at your level of government. 

[00:01:26] What drives you to still be interested in education and passion in that world?

[00:01:31] Stefano Scalzo: Well, look, I think it's a lot to do with advocacy. 

[00:01:35] I feel that it's important that people in my position, not only think about the process by which we follow to get things done, but once they are done, that they meet the best thinking of the time.

[00:01:48] And that really requires of all of us who are in the decision making roles to be at the forefront of thinking rather than default to, well, this is what we've done last time. 

[00:01:59] So it's incumbent upon me to stay fresh, stay live, have these conversations with people like yourself and others, just to ensure that we're imbuing our projects with the very best thinking. 

[00:02:11] David Cummins: Yeah, I totally agree. I think when you really challenge people about why they're doing something, and a lot of time the answer is, "Oh, we've done it this way forever". 

[00:02:20] But if you really look at research, you can actually challenge a lot of thinking, even with user groups or with design innovation or technology. 

[00:02:28] And I find that a lot of people in our industry don't really embrace it enough or challenge what has been done in the past.

[00:02:37] Stefano Scalzo: Yeah, look, and I think that's really coming out now in a lot of the conversations we're having when we talk about co-design in the mental health space. You have consumers, people with a lived or living experience as part of our consulting group. 

[00:02:51] And it's a little unfair to ask some of these people what do you think should be the best environments now, clearly from their own experience, they'll have an opinion.

[00:03:01] However, they are surrounded by a lot of people with perhaps a lot more experience in seeing alternatives. And so therefore it's incumbent upon the project group to share that knowledge, to share the knowledge of how things could be different.

[00:03:14] And that's part of the co-design co creation process as well.

[00:03:18] And so therefore, I think the LinkedIn posts and other things are all a way of disseminating information about what's the latest, how can we incorporate some of this latest thinking and how can we share it so we all coming at the question about design equally and no one group is advantage more than anyone else.

[00:03:37] David Cummins: Yeah. And also the part of that is sharing. 

[00:03:39] Ultimately it's for patient care, so we should all be on that journey together. You know, it's not necessarily competition. It's actually, what can we do to share that knowledge for better patient outcomes? 

[00:03:49] Stefano Scalzo: That's right. 

[00:03:50] And it was interesting in my practice days, it was always instructive on the first user group to ask people who are in the room, put your hand up if you're going to be here when the project is finished.

[00:04:00] There was very little hands that went up, and there's always something about people who are senior enough to be in those user groups are sometimes not the people who are going to be around to actually live the experience of that facility. 

[00:04:14] So sometimes we don't have things quite right and that sometimes we should be engaging people with new and fresh and young ideas to really get us future ready in some of our thinking. 

[00:04:25] David Cummins: And speaking of future ready, Victorian health is doing a lot of infrastructure. It seems like there are so many cranes up, certainly in Melbourne, and I've done a few drives around Victoria, there is a lot of work happening in Victorian health.

[00:04:38] For those of you that are not so familiar with what's happening in Victoria at the moment, you might just give it a bit of a overview about what's happening now and what's in the future of pipe work?

[00:04:47] Stefano Scalzo: Yeah, look it's been an interesting trajectory, David and I'm sure you know it.

[00:04:50] When I started in this gig back in 2016, I think we, on average, would receive between 700 million and a billion dollars per annum for projects. 

[00:05:01] And I think we were tracking the portfolio was something in the order of two to three billion dollars. 

[00:05:06] That skyrocketed over the past four or five years up into that 7 billion mark and based on the previous election, which we had late last year, we're now at around $12 billion committed and projects actually in delivery. 

[00:05:23] And that's if you exclude the redevelopment of the Royal Melbourne Hospital. 

[00:05:28] And once you add that into it you can see you can get very close to a 20 billion worth of activity.

[00:05:34] And these are very large numbers and almost very difficult to actually compute the magnitude of them. However, it's important to think about every one of those dollars. 

[00:05:45] Yes, it's important for health infrastructure and yes, it will accommodate important provision of services. 

[00:05:51] Each one of those dollars can create more value for sites around the hospital campus, you know, precincts. 

[00:05:58] We talk a lot about education and health precincts and in some instances, certainly in the case of the RMH project, we're activating precincts. We're the first non-rail road project to go into a precinct to really act as that kind of carrot to attract investment. 

[00:06:17] So, I think that goes to the core of the success in Victoria and in other parts of Australia, for that matter, in people in my role around the country, talking about health infrastructure as being something greater than the delivery of health services, which is absolutely the core and most fundamental aspect of it.

[00:06:39] But at the end of the day, these are huge investments that government gets a better return on their investment if it can create, activate and uplift the value of properties around it such that it attracts greater investment by private providers and others. 

[00:06:56] But also synergistic developments like co-worker housing, we all know that the best researchers have families, they need kindergartens, they need schools. 

[00:07:05] And so to think about it, stepping back and thinking of health and health infrastructure as part of the. bigger fabric of the community, it's the thing that gets me up every day.

[00:07:15] And it's the thing that we've had some success in advocating for down here in Victoria. 

[00:07:23] David Cummins: Yeah. 

[00:07:24] When you're talking about community health... generally speaking, certainly in the older days, the hospital was the heartland of a regional town and everyone knew where the hospital was, you generally knew someone working at the hospital.

[00:07:35] It generally was the community jewel of many towns. 

[00:07:38] So it seems like at one point we went away from that a little bit, but now it's really coming back to try and get more community involvement into the actual health precinct. 

[00:07:48] That's generally happening regionally, but, do you think it's happening more metro? 

[00:07:53] Is that still a while away? Or what do you think about that? 

[00:07:55] Stefano Scalzo: Look, I think there's something about the immediacy of how it can happen at a regional level that takes a while in a metropolitan setting.

[00:08:04] And it's a bit cheeky, but I'm thinking of Albury Wodonga Health. We're working with our colleagues in New South Wales at the moment on the Albury hospital redevelopment, which in and of itself is unprecedented to have two governments come together.

[00:08:18] In fact, and working with the federal government to fund the redevelopment of the Albury campus. 

[00:08:23] I think of the potential that that has to activate the precinct in a very immediate way. 

[00:08:29] Land values are probably not as prohibitive for other markets entrants to come in and buy and develop the land.

[00:08:37] So there's an immediacy that can happen in a rural in a regional setting that may take a little longer in a metropolitan setting. 

[00:08:46] That said, I think of the RMH in Parkville and It's a ready made precinct even if it hasn't necessarily been curated in that way. But it's interesting to watch the history of Parkville at a certain point, probably 15, 20 years ago when people went from, Oh, actually, it's just an accretion of like minded entities coming in and around the same geographical area to saying, "Oh my God, we are next to each other and we can be greater than the sum of our parts" if we only promoted ourselves in that way. 

[00:09:19] So there is a little bit about things happening haphazardly, coming together and then flipping it on its head to say, well, actually, this is a strength of ours, we can leverage this.

[00:09:30] And I think that happens equally in metropolitan Melbourne, as it can happen in regional. Victoria or regional Australia, and it's a little bit about how you curate the message around these types of initiatives that, at some point, you get to a critical mass and you can leverage that mass to become even even greater, have greater impact on the cities around you and the communities around you.

[00:09:54] David Cummins: So as the main representative for those projects from many points of view, how do we, as in the government and you, go about prioritising these projects?

[00:10:05] It's a lot of money, there's a lot of need, it's a big state. 

[00:10:09] We're post COVID. There's a lot of failing infrastructure in some parts, but there's also a lot of booming in some parts.

[00:10:14] So how do you actually go about the prioritisation of that? 

[00:10:17] Stefano Scalzo: This is a conversation that jurisdictions or people in my role are having up and down the Eastern Seaboard. 

[00:10:24] And that is, you're quite right, how do you prioritise one project over another? And the need is so great, particularly when it comes to replacing existing outdated infrastructure, let alone growing it to the capacity that it needs to meet future population demand.

[00:10:42] That said, I think you need to look at both the service need and that growth and the existing asset base. 

[00:10:49] And you need to take pretty good measure of the fever in each through some sort of database, which we're fortunate, we've actually developed over the COVID years, we developed a really strong needs based model and an asset information model.

[00:11:05] And we combine those two things to develop a prioritisation within metropolitan Melbourne and regional Victoria. 

[00:11:14] And that prioritisation is just a start. It basically says with limited planning funds, where should we look or where should we focus our effort to identify the appropriate investment for those top five metro, top five regional. 

[00:11:30] But they become the priorities of the department. It shouldn't preclude, though the enormity of endeavor that health services themselves undertake to do planning and they will go ahead and do planning and we support them to do that planning work. 

[00:11:46] And there are other pathways by which things get funded. Not always the highest priority projects get funded. 

[00:11:53] We certainly have priorities as a department. I know our equivalents in New South Wales and Queensland do something similar to us. But we also support health services here in Victoria or LHDs in New South (Wales) or Queensland for that matter to do their planning and advocate for their projects as well.

[00:12:12] So hopefully that gives you a sense of how we do it, but it does mean that unfortunately, despite how big the pie seems to be for health infrastructure, we know that there's still more that needs to get done. 

[00:12:26] And it's how do you keep advocating for that more investment, knowing full well that you've got to be fiscally responsible at some point as well.

[00:12:34] You can't just constantly be building new infrastructure. There's got to be other ways of dealing with demand and there's some of the things that we're turning our mind to over the course of the next five to 10 years. 

[00:12:45] David Cummins: Yeah. It's a perfect segue because that was my next question, I know traditionally, a lot of other states have had mini hospitals but generally speaking, you hear more about the bigger hospitals, certainly in Queensland, in Perth, in Adelaide, in New South Wales. 

[00:12:59] But Victoria sort of pivoted a little bit recently, a few years ago, where you've actually got some more community hospitals and I think they're in construction now, I don't think they're open yet.

[00:13:08] The other states haven't really probably embraced that as much. I know they're doing a little bit, but I think it was 10 from memory that you've actually rolled out. 

[00:13:15] I think it's a phenomenal innovation, smaller, more regional, higher volume and, you know, transfer to the hospital if you need to. So where did that come from? 

[00:13:24] Stefano Scalzo: Yeah, although they're called community hospitals now, they were the centrepiece of the 2017 Statewide Services and Infrastructure Plan and they were called health and wellbeing hubs. 

[00:13:34] And I dare say that the genealogy of those particular types of facilities, we're back in the super clinics. We did a few of those when I was still practicing at Lyons back in the mid to late nineties.

[00:13:48] And before then there was some other integrated community care type facility. So they've been kicking around a while, or they've got a new name now 'Community Hospitals', but they are doing the same sort of thing, David. 

[00:13:59] And that is it's diverting activity that would otherwise go to an acute setting and unfortunately block that up because you don't have enough beds, you don't have enough flow through those facilities. 

[00:14:13] And sometimes those hospitals can be further away from community setting. So this is acknowledging, can we add another tier in our arsenal of accommodation that can actually get more done closer to where people live and avoiding that unnecessary.

[00:14:31] Presentation to an ad for what is effectively a category four and five. And some of these community hospitals will be able to do a little bit more than that from an acute end, but certainly all that ambulatory work dialysis, you know, day medical, all that work that can be done closer to where someone lives, integrated into their community so it's easy for someone to go and pick them up after a session on the chair or what have you. 

[00:14:53] And equally for some of those higher throughput, low complexity interventions that could happen in procedure rooms and or in areas where people can easily recover in a community hospital. 

[00:15:05] That's the idea. They don't have overnight beds. So they kind of stop at that, dare I say, day surgical level of complexity. 

[00:15:12] But they're all designed for that quick, high throughput, or, you know, frequent flyer type activity that can be taken out of the bigger hospital and thereby clear up some space there for what is essentially enormous amounts of growth we're seeing in and across Melbourne.

[00:15:30] David Cummins: Now, I have to ask this question I know we're running out of time, but, I love infrastructure, I love health infrastructure, I love designing, I love building but there is some... hospitals around Australia at the moment and around the world that are these big brand new hospitals that are not opening at full capacity, which was planned or unplanned.

[00:15:48] And the aging population is doubling in the next few years, but resources just seems to be a consistent global concern. 

[00:15:58] Great new infrastructure, but who's going to staff them? 

[00:16:01] How do we get around that issue where we've got these brand new hospitals or we've got these plans, but we don't have the staff to manage them?

[00:16:09] Stefano Scalzo: Yeah, well, you're talking to the wrong guy, right? You're talking to the infrastructure guy. There's a couple of things, right. 

[00:16:15] You know the first thing that I think all of us involved in infrastructure should just maybe take a a cold drink, a chill pill and just remember that buildings don't cure people, people cure people, right. 

[00:16:27] So you can have the worst building in the world. As long as you've got the best people, people get better outcomes. 

[00:16:33] So that's something we all in the infrastructure space need to remember. And I guess the second thing though, at the right opposite end of that, I'm often reminded of the transformation in the nineties in the university sector at RMIT and certainly at other universities around Victoria, there was this real recognition that the built environment assisted in the attraction and certainly the retention of staff.

[00:16:59] And what we're finding is something similar is happening in Victoria and certainly in metropolitan Melbourne. And we know that because we've got an enormous, like all states across Australia and indeed other jurisdictions around the world, everyone's on a huge recruitment drive.

[00:17:15] And I think we get nurses from Ireland and a few of ours go back to Ireland. I don't know.. Probably.. It all balances itself out. 

[00:17:22] But what's interesting is if you've got a new Footscray hospital and staff need to pick between a new Footscray hospital or some hospital like the Alfred, it's a line ball, right.

[00:17:35] You know, cause they know that at Alfred, they're going to be doing some pretty amazing work, right, not to say that the work of Footscray isn't amazing, but it's just to say, you know, if you're wanting to really do specialised work, the Alfred, particularly in trauma or heart, that's the place you want to be. 

[00:17:50] But let's face it, it's a well outdated environment that is well due for a redevelopment, but you know it's a matter of degrees, people might go for that, but they might, but they're also telling us, well, my God, you know, this new hospital, it looks pretty good, pretty shiny and everything seems to work.

[00:18:06] Everything's laid out and so as I can be the best. possible nurse or clinician I can be because someone's really thought hard about how I work and the models of care and so on and so forth. 

[00:18:17] And the environment's going to support me, be the best I can be. So we're hearing that but whether that gets everyone over the line at the end of the day, these are people I think certainly my experience that these are clinicians who, like we all do, thrive on a challenge in their work environment and sometimes unfortunately where the greatest challenges as a clinician are also happen to be some of our worst environments here in Victoria.

[00:18:45] So it's interesting. 

[00:18:47] It does come down to individuals, but we do know that more and moreso new environments are attracting and helping retain staff. 

[00:18:54] We know this, particularly in regional settings in our public sector, residential aged care areas where, you know, unfortunately, you'll have staff who in very cramped rooms needing to lift immobile elderly residents and the OH&S claims, as many people would know through the roof, but in a new public sector, residential aged care facility, particularly down here in Victoria...

[00:19:17] You know the before and after shots are incredible and I pretty well know that if you're working in residential aged care, you want to go to one of those new environments if you can, because it's certainly going to mean you're going to have a longer career in terms of your back and other OH&S related issues. 

[00:19:35] David Cummins: It sounds like a good problem that we can continue to discuss.

[00:19:38] And I think that's the beauty of health because there's so many things we can work on. 

[00:19:43] I just want to say thank you so much for your time today. I know you're super busy. 

[00:19:46] You're someone that I look up to tremendously, you've been leading Victorian health infrastructure for many, many years. 

[00:19:53] If people don't know you, they certainly know of you and it's, it's all very good news.

[00:19:57] I just want to thank you so much for your dedication to this industry, to Victoria especially. I know you work very hard and I just think without people like you, we'd actually be a few years behind. So I know your innovation and research helps push us forward. 

[00:20:08] So thank you so much.

[00:20:09] Stefano Scalzo: Thanks, David. Really enjoyed it and look forward to hearing the recording at some point. 

[00:20:14] David Cummins: Thank you. 

[00:20:15] You have been listening to the Australian Health Design Council podcast series, Health Design on the Go. 

[00:20:19] To learn more about the AHDC, please connect with us on our LinkedIn or our website.

[00:20:24] Thank you for listening.