S9 EP3: Priscilla Radice, Government Goodies

Priscilla provides deep insight into the vast amount of work in QLD Health and the challenges of building in the most expensive place to build in Australia.

If you'd like to learn more about the AHDC, please connect with us on our website www.aushdc.org.au or on LinkedIn at linkedin.com/company/aushdc.

Transcript

[00:00:00] David Cummins: G'day and welcome to the Australian Health Design Council podcast series, Health Design on the Go.

[00:00:20] I'm your host, David Cummins, and today we're speaking to Priscille Radice.

[00:00:24] Priscilla is a dynamic leader who has driven person-centered design, efficient and sustainable results throughout her career. 

[00:00:31] Her expertise includes management of significant transformational programs, shaping new operational models and leading system reform.

[00:00:39] In August, 2022, Priscilla was appointed the Queensland Health's Deputy Director General, Health Capital Division, to deliver Queensland's largest ever infrastructure program. 

[00:00:50] The $14 billion investment is to help create quality build environments that support world-class healthcare. 

[00:00:58] HCD partners with stakeholders to manage infrastructure delivery, provide expert advice and manage health assets, whilst also monitoring and reporting on capital and asset management.

[00:01:08] Welcome, Priscilla. Thank you for your time to be here. 

[00:01:11] Priscille Radice: Oh, thank you, David. 

[00:01:12] It's a real pleasure to be here, and I love the concept of the podcast and the title of Government Goodies. 

[00:01:18] David Cummins: Yeah, it's Government Goodies, so we're lucky to have managed to get... It's pretty much everyone around Australia, which is good.

[00:01:23] And I must admit, speaking to all the other governments, you would by far have the biggest budget with $14 billion. 

[00:01:30] That seems like a lot of money and a lot of investment. Where did that come from? 

[00:01:35] Priscille Radice: It is an extraordinary commitment that the Queensland Government has provided to health. So last year, the health and hospitals plan was stood up to provide a certain pipeline that is fully funded, committed and announced.

[00:01:48] And the intent of that was to be able to manage it at a program-wide level so that we could bring in a whole pile of innovations for how we deliver infrastructure and health. 

[00:01:58] We could look at opportunities for standardisation but that we could really focus on delivering the needs that Queenslanders need.

[00:02:06] It's a really big state, it's a very diverse state with a really spread population, different to other states. And there was just a very strong commitment recognising how important health is to every single community member to really invest in infrastructure. 

[00:02:22] And the intent of this is that it is the first tranche of a 15 year plan. So this is the public first five year plan but we are also doing all of the business case and the work to work through what we think our infrastructural needs will be against service need as well as asset condition for the 10 years after that. 

[00:02:42] So we are really standing ourselves up for the long term here.

[00:02:45] David Cummins: For those of you that don't know much about Queensland Health, do you mind just highlighting exactly where those facilities will be located? 

[00:02:54] Priscille Radice: It's spread right across Queensland. So the biggest program that makes up that nearly just over 14 billion now is the capacity expansion program. So that program is made up of three Greenfield hospitals.

[00:03:06] So a new hospital in Coomera, in Bundaberg and in Toowoomba, we also have the brand new Queensland Cancer Centre that will be a cutting edge, fully integrated, really taking cancer services from diagnosis all the way through to survivorship, which we're very, very excited about. 

[00:03:26] Then we have a range of other major expansions. So those expansions are in Cairns, they're in Townsville, they're in Mackay they are in a range of locations in South East Queensland and they're all big expansions into existing hospitals. 

[00:03:43] And we also have a new expansion that we're doing in Robina as a lease agreement, which more information will be coming out in regards to that. 

[00:03:52] We also have the building rural and remote program, which is a country girl from Western Australia originally... it's very close to my heart... where we are looking at replacing and refurbishing a range of rural hospitals and health facilities throughout a very big diverse state.

[00:04:08] So we have many of those in Torres and Cape in the Northwest, in Southwest, in Darling Downs, scattered throughout the state. 

[00:04:15] So it's a big program of work which we're really looking at what our opportunities are for standardised design. 

[00:04:21] We're using modern methods of construction and we're really thinking about rather than continuing to try and bandaid older buildings, how do we have a program of work where we can build, state of the art, new, but affordable based on the models of care and the community needs of today, for many of these hospitals were built, early in the 1900s. 

[00:04:42] David Cummins: I'd almost challenge you, not only the models of care for the needs today, but for the future as well, I imagine. 

[00:04:47] Priscille Radice: Completely. 

[00:04:48] So our role at Health Capital Division is to build flexible future fit infrastructure to create sustainable health services.

[00:04:58] So we are very, very focused on what does that mean and how do we manage to do that. We do not want to look in the rear view mirror after the next five years and have missed a whole pile of opportunities to do things differently. 

[00:05:11] But we're also very conscious that we are operating in an accelerated environment with a really, really big build. And it's an interesting space where there's a lot of conversations around what will the future of care look like. 

[00:05:22] We are very focused and have, in the Queensland Health, the Vision 32 document, care closer to home and care within the community is a big part of what we're doing. 

[00:05:31] And so what does that mean from an infrastructure perspective where we're not just defaulting to assuming it is always a big build, that what are the opportunities around optimisation of what we have and what are the opportunities within communities?

[00:05:44] There's some really great work happening with Children's Health Queensland around integrated hubs where we're looking at education, we're looking at other elements in the community, allied health, referral services, women's services. 

[00:05:57] You know, the first 2,000 days of children is so critical.. 

[00:06:00] What does that mean for these integrated facilities within community hubs, where people are already interacting for other services?

[00:06:07] So we are quite focused on how we don't just continue to just build more, but we build the right things at the right time. 

[00:06:15] David Cummins: I think you've just made a lot of people happy, especially in the research space and the health space because flexible health is so important, especially for future generations, especially when you look at the aging population going to double in the next 10 to 15 years.

[00:06:31] And there's a lot of white papers out at the moment saying we don't even have enough beds, what do we do? 

[00:06:35] So I think you're a hundred percent right. 

[00:06:37] The way government and other people should be looking at health now is to challenge the current and traditional models of care for future growth. 

[00:06:45] Priscille Radice: And the models of delivery.

[00:06:47] So we do have the biggest public pipeline of work, but you know, what is the role for philanthropy? 

[00:06:53] What is the role for the private sector to work on models that are more sustainable in the long run for whole of life decisions for what are the ways to deliver infrastructure. 

[00:07:03] And how do we take an outcomes based approach. 

[00:07:06] So I've spent a lot of time, we're doing some work around our residential aged care facilities at the moment. 

[00:07:11] Amazing community members, they do fantastic work and have met many beautiful residents. But I'm not sure that my generation is going to want to be in that type of environment.

[00:07:23] I think the next generations coming up have a very different view of what retirement life might look like and what is the opportunity to capture in my generation, people in their 50s who are more than likely going to be working well into their 70s, but will be working in a different way and will want to retire in a different way.

[00:07:42] What does that infrastructure look like and what do those partnerships look like with the community members that might want to invest in a way that's not just about investing and trying to maintain their own kind of retirement, but how do they invest in something collective potentially to know that there's going to be an outcome for the type of lifestyle that they want in the future?

[00:08:01] David Cummins: Yeah, you're a hundred percent right. Especially considering the aged care review that came out a few years ago, Australia doesn't do aged care very well, retirement very well. 

[00:08:08] When you look at places like Europe and Scandinavia especially where it's an honour to get old and an honour to be respected in nursing homes.

[00:08:15] So I do think there is an opportunity there for improvement and to enhance that model of care as we get older. 

[00:08:21] Priscille Radice: Yeah, it's some really interesting work that we're embarking on now in that space, which is great. 

[00:08:25] We've just opened the first three satellite hospitals of the Satellite Hospitals Program. We've got another two opening later this year, and then two more by the middle of next year. 

[00:08:36] And they are already fulfilling our expectations around the community walking into the centers with the minor injury and illness clinics, but also there's a range of referral services for care closer to home that doesn't need to be on a major hospital.

[00:08:51] And they've been very, very successful and lots of lessons learned coming through, but overall... it's an interesting conversation around demand and how much unmet demand there is. 

[00:09:01] And as we move towards infrastructure solutions, but also the increasing demand at the same time that is still skyrocketing.

[00:09:09] And so this piece around our services and how we deliver them and community expectations around consumer choice. I think is really, really important as well. 

[00:09:18] Consumers have an expectation that they will have control through their health journey and how do we enable that? 

[00:09:24] David Cummins: Yeah, I 100 percent agree.

[00:09:26] I just want to touch base with something you said at the start about innovation and technology... I've been doing this podcast for a while now and it seems like something, especially over in Europe and Canada where they really are embracing AI, innovation and technologies. 

[00:09:41] One of the purposes of this podcast is to really identify the latest innovation trends when it does come to patient care and design.

[00:09:48] How important was Innovation as part of a marking criteria for your designers and your builders and your PMs and your QAs. 

[00:09:55] I imagine innovation would have been a high priority for marking criteria. Would that be correct? 

[00:10:01] Priscille Radice: Yeah, look, it's an interesting one because our big expansion is, we need to deliver beds and we need the support services to go with the beds.

[00:10:08] What we're trying to do is allow for those innovations in the future. I've just hired an amazing professional in AI who is doing his PhD in this space around skin cancers and being able to map and track and use AI to be able to pick up where we're going to see things before they get there across community cohorts.

[00:10:27] The ability to use digital twins for our infrastructure, what are we using our BIMs for, how are we converting and using. 

[00:10:35] We are using VR and have opened up the trenches of all of our designs for our rooms to all of the clinicians while we were in tender. Because we're setting the design principles for Queensland Health that are against place technology value and people.

[00:10:52] And those design principles needed to be addressed in everyone's tender back to us from the contractor through to the consultants, through to the engineers and the architects, because we're trying to achieve those principles over time. 

[00:11:05] We won't get to all of them on every build, because this is a a process around how, how we get to where we need to go. 

[00:11:12] But we have to allow for those innovations because I will talk to three or four different clinicians or different experts. And I've just been in Victoria, I've been in New South Wales as well as across Queensland and I can get quite completely mutually exclusive advice. 

[00:11:29] A clinician will tell me this is where something's heading and a clinician will tell me the complete opposite of where something's heading. So there is a lot of noise around the space for what are these predictions and how do you make those predictions. 

[00:11:42] There's another division that I work with, clinical planning and service strategy, and they are setting up a whole research unit. A lot of the innovations happen on the ground with the clinicians, patients with the community, the HHSs at the patient face of what we're doing and how do we capture all of those across a big complex ecosystem, work out which ones can scale and how do we then support them to scale?

[00:12:04] David Cummins: Yeah, it sounds fascinating. I did want to also touch base on sustainability, something that I pushed pretty hard with my projects, and I think it's something that, to be brutally honest, governments probably haven't embraced as much as they should have to this point, now we've got 2030 up the road. 

[00:12:22] Is Queensland government taking sustainability seriously when it comes to all these brand new designs and all this infrastructure?

[00:12:28] Priscille Radice: Look, sustainability is a very big focus for the government. 

[00:12:32] Certainly around carbon neutral, there is legislation now around our target when we need to get to carbon net zero. I think it is fair to say that we're working through the implementation of how we achieve that.

[00:12:43] The biggest impasse from a sustainability and a footprint from a climate point of view is in the operations of hospitals. 

[00:12:50] So if we think about waste, if we think about energy usage, we think about the backup for energy with diesel generators to make sure that in the event that you've got certainty.

[00:13:01] We are really focused on what are the elements around future of energy and what are the decisions we need to make with the creation of the health capital division, we can start to look at these at a statewide level rather than every health and hospital service needing to try and find a solution on their own.

[00:13:16] We're on a journey, there are a lot of people that are very passionate about it, we need a really, really clear strategy around it. 

[00:13:24] I think what has happened in the past is that from an infrastructure point of view, sustainability things tend to get value managed out. Because if you put sustainability against patient and clinical care, in a health setting, clinical care will always win.

[00:13:39] So how do you think about what are the sustainability aspects when you've got tight budgets and projects? What are the pathways for funding? What are the different implementations? 

[00:13:48] How do we do it at a program level or how do we ensure that we're ring-fencing it so they're not elements that can be value managed out because you can't have those two things competing against each other.

[00:13:58] When you truly think about sustainability is not just about environment. Sustainability is a true kind of every factor around community and place. And those two things, you know, you've got to be looking after people sustainably and place sustainably. 

[00:14:15] And at the moment, there is a competitive environment, I think, more broadly, which is what creates some of those issues in all sectors.

[00:14:23] David Cummins: Yeah, I've actually written a PhD plan about how to reduce the carbon footprint of Australian healthcare. 

[00:14:29] And there is a big competing interest for clinical versus sustainability, but also what it comes down to is that leadership piece of making sure it is a high priority when it does come to future projects.

[00:14:42] And if you do have a budget for it versus being allowed to be value managed out, you do get positive outcomes, but it does come down to a very strong conversation and setting that agenda right at the start, about what what to do and how to do it 

[00:14:55] Priscille Radice: Agreed, David. Yeah, absolutely. 

[00:14:57] And I think that that's increasingly becoming a compromise that is no longer acceptable.

[00:15:02] I'm a big fan of compromise. I think compromises is the art of getting where you need to go. But sometimes I think you default to a compromise that is no longer acceptable. 

[00:15:12] David Cummins: Yeah, 100 percent agree. I just had one last question before we go. It's come up a few times around Australia with all of these podcasts that I say... what about resourcing?

[00:15:20] Surely that's something that has to be considered post-Covid. And I think with the aging population, like it's good to build, but it's also important to operate. 

[00:15:29] So is that something that is a concern for the government or it's something that everyone has worked out or is it on the radar? 

[00:15:36] Priscille Radice: No, it's definitely on the radar.

[00:15:37] There is a new workforce strategy that is being led, not by my division, but it is a really big part of what we're doing to work through. 

[00:15:46] We used to do really, really detailed workforce strategies on these big builds right at the beginning, and of course, you'd have to redo them.

[00:15:53] So what we're trying to do at the moment is work through the broad and we have worked through the broad implications from a workforce point of view, but we're also trying to do the more detailed workforce closer to when we're going to be operating and commissioning so that we can really work through with the clinicians.

[00:16:09] Those innovations, those elements, those equipment, those changes, but also we're doing partnerships with the medical schools talking through placements and the actual pipeline of people. 

[00:16:21] And we've also introduced some initiatives around attracting staff, especially into rural and remote areas.

[00:16:27] We've also got a whole staff accommodation program. We know that when we're attracting people into a rural and remote big country state like Queensland, that we need to be able to provide a home away from home. 

[00:16:38] So there's a number of different things that we're doing to both attract and retain staff and do our planning for our workforce strategy.

[00:16:46] David Cummins: Priscilla, I just think you are amazing. 

[00:16:49] At the start, I said you're a dynamic leader. I would emphasise that by a phenomenal leader. 

[00:16:53] I think you're Passion to this industry and to the state of Queensland is absolutely second to none. With you at the helm, I have no doubt everything will work and go to a tee and on time and on budget.

[00:17:05] I just want to thank you so much for your time and dedication to Queensland, time and dedication to public health and to the community and to the health sector. 

[00:17:13] It is people like you that have made us get this far and certainly you'll be breaking down those barriers for the future and for future generations.

[00:17:20] Thank you so much and good luck for the next few years. 

[00:17:23] Priscille Radice: Thank you, David. 

[00:17:24] Thank you for doing these sorts of things. It's a big commitment to have your day jobs and provide support into such important contributors. And it is a big responsibility, but a privilege to work in the health industry.

[00:17:36] Every day you're so connected to purpose and it's joyful. 

[00:17:40] David Cummins: You have been listening to the Australian Health Design Council podcast series, Health Design on the Go. 

[00:17:45] To learn more about the AHDC, please connect with us on our LinkedIn or website. 

[00:17:49] Thank you.