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Parzonka K, Ndayishimiye C, Domagała A. Methods and Tools Used to Estimate the Shortages of Medical Staff in European Countries-Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2945. [PMID: 36833641 PMCID: PMC9957245 DOI: 10.3390/ijerph20042945] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/03/2023] [Accepted: 02/05/2023] [Indexed: 06/18/2023]
Abstract
Healthcare workforce (HWF) shortages are the biggest challenges today in healthcare systems. Therefore, it is crucial to forecast the future needs of HWFs in order to plan accordingly. The purpose of this study was to identify, map, and synthesize the tools, methods, and procedures for measuring medical staff deficits in Europe. We used the Arksey and O'Malley scoping review methodology. Based on predefined criteria, 38 publications that were retrieved from multiple scientific databases, hand-searched on the internet, from relevant organizations, and scanned from references were considered. They were published between 2002 and 2022. There were 25 empirical studies, 6 theoretical papers, 5 reports, 1 literature review, and 1 guidebook. The majority estimated or measured shortages of physicians (14/38) and nurses (7/38) or looked at HWF generally (10/38). Various methods were used, including projections, estimations, predictions, simulation models, and surveys, which used tools such as special computer software or customized indicators, i.e., the Workload Indicators of Staffing Need method. Researchers estimated HWF shortages at both national and regional levels. Such projections and estimations were often based on demand, supply, and/or need. These methods and tools are not always suited to the needs of a country or medical facility, which is why they need to be further developed and tested.
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Affiliation(s)
- Kamila Parzonka
- Doctoral School of Medical and Health Sciences, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Costase Ndayishimiye
- Health Economics and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, 8 Skawińska St., 31-066 Krakow, Poland
| | - Alicja Domagała
- Health Policy and Management Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, 8 Skawińska St., 31-066 Krakow, Poland
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Kowalski C, Brinkmann A, Böhlen CFV, Hinrichs P, Hein A. A rule-based robotic assistance system providing physical relief for nurses during repositioning tasks at the care bed. INTERNATIONAL JOURNAL OF INTELLIGENT ROBOTICS AND APPLICATIONS 2022. [DOI: 10.1007/s41315-022-00266-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractIn nursing care, physical overload is an important issue that plays a main role in adding to the number of sick days or even causing staff to withdrawal from the profession. In addition to existing physical aids, robotics in particular has the potential to provide general physical relief during extremely stressful care activities provided at the bedside by performing assistance activities. To shed more light on the relief potential offered, we conducted a study involving 12 caregivers who used a lightweight robot attached to a nursing care bed to assist in the repositioning process. We relied on a robot system architecture that enables rule-based movement adjustments in real time using the Robot Operating System and Unity. The study focused on the repositioning of a patient simulator from the supine to the lateral position. The comparison of the measured ground reaction forces and muscle activity data suggests that robotic assistance during the performance of the activity reduces load peaks and generally leads to more attenuated ground reaction force curves, which results overall in a healthier way of working. With robotic assistance, the average back extensor muscle activations were 25.7% lower compared to conventional repositioning. In addition, the measured maximum occurring muscle activations were reduced by 61.2% when the robotic assistance system was deployed.
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Ose SO, Færevik H, Håpnes T, Øyum L. Perceived causes of work-related sick leave among hospital nurses in Norway: a pre-pandemic study. Saf Health Work 2022; 13:350-356. [PMID: 36156869 PMCID: PMC9482014 DOI: 10.1016/j.shaw.2022.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/18/2022] [Accepted: 04/08/2022] [Indexed: 11/29/2022] Open
Abstract
Background Although sick leave is a complex phenomenon, it is believed that there is potential for prevention at the workplace. However, little is known about this potential and what specific measures should be implemented. The purpose of the study was to identify perceived reasons to take work-related sick leave and to suggest preventive measures. The study was completed before the COVID-19 pandemic emerged, and the risk factors identified may have been amplified during the pandemic. Methods An in-depth cross-sectional survey was conducted across a randomly selected sample of hospital nurses in Norway. The national sample comprised 1,297 nurses who participated in a survey about their sick leave during the previous 6 months. An open-ended question about perceived reasons for work-related sick leave was included to gather qualitative information. Results Among hospital nurses, 27% of the last occurring sick leave incidents were perceived to be work-related. The most common reasons were high physical workload, high work pace, sleep problems, catching a viral or bacterial infection from patients or colleagues, and low staffing. Conclusions Over a quarter of the last occurring sick leave incidents among Norwegian hospital nurses are potentially preventable. To retain and optimize scarce hospital nursing resources, strategies to reduce work-related sick leave may provide human and financial benefits. Preventive measures may include careful monitoring of nurses’ workload and pace, optimizing work schedules to reduce the risk of sleep problems, and increasing staffing to prevent stress and work overload.
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Hander NR, Gulde M, Klein T, Mulfinger N, Jerg-Bretzke L, Ziegenhain U, Gündel H, Rothermund E. Group-Treatment for Dealing with the Work-Family Conflict for Healthcare Professionals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11728. [PMID: 34770242 PMCID: PMC8583074 DOI: 10.3390/ijerph182111728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/31/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022]
Abstract
Healthcare professionals' exposure to work-family conflict negatively affects the health and well-being of the whole family and organizational outcomes. Specified workplace interventions are lacking. Therefore, the aim of the study was to evaluate the feasibility of a two-day group-treatment specifically designed for the needs of healthcare professionals with family responsibilities concerning participation, satisfaction with the intervention and family- and individual-related outcome variables. 24 mostly female (85.7%) participants of a community hospital in southern Germany attended the treatment. Data were collected at baseline (T0), directly after the treatment (T1) and two months later (T2). A two-factor analysis of variance with repeated measures showed a statistically significant time x group effect for self-efficacy (F = 5.29, p = 0.011). Contrasts displayed substantial pre-post (T1-T0, T2-T0) increases of self-efficacy in the intervention group as compared with the control group. Non-parametric Mann-Whitney-U tests are in line with these findings. The results indicate that the group-treatment adapted to the needs of healthcare professionals has the potential to boost self-efficacy among healthcare professionals and that participants were predominantly satisfied. Perspectives for future research and practical implications are discussed in the light of the manifest lack of healthcare professionals.
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Affiliation(s)
- Nicole Rosalinde Hander
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, 89081 Ulm, Germany; (T.K.); (N.M.); (H.G.)
| | - Manuela Gulde
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University Medical Center, 89075 Ulm, Germany; (M.G.); (U.Z.)
| | - Thomas Klein
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, 89081 Ulm, Germany; (T.K.); (N.M.); (H.G.)
| | - Nadine Mulfinger
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, 89081 Ulm, Germany; (T.K.); (N.M.); (H.G.)
| | - Lucia Jerg-Bretzke
- Department of Psychosomatic Medicine and Psychotherapy, Medical Psychology, Ulm University Medical Centre, 89075 Ulm, Germany;
| | - Ute Ziegenhain
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University Medical Center, 89075 Ulm, Germany; (M.G.); (U.Z.)
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, 89081 Ulm, Germany; (T.K.); (N.M.); (H.G.)
| | - Eva Rothermund
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, 89081 Ulm, Germany; (T.K.); (N.M.); (H.G.)
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Johnson D, Ouenes O, Letson D, de Belen E, Kubal T, Czarnecki C, Weems L, Box B, Paculdo D, Peabody J. A Direct Comparison of the Clinical Practice Patterns of Advanced Practice Providers and Doctors. Am J Med 2019; 132:e778-e785. [PMID: 31145882 DOI: 10.1016/j.amjmed.2019.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/22/2019] [Accepted: 05/08/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Rising health care costs, physician shortages, and an aging patient population have increased the demand and utilization of advanced practice providers (APPs). Despite their expanding role in care delivery, little research has evaluated the care delivered by APPs compared with physicians. METHODS We used clinical patient simulations to measure and compare the clinical care offered by APPs and physicians, collecting data from 4 distinct health care systems/hospitals in the United States between 2013 and 2017. Specialties ranged from primary care to hospital medicine and oncology. Primary study outcomes were to 1) measure any differences in practice patterns between APPs and physicians, and 2) determine whether the use of serial measurement and feedback could mitigate any such differences. RESULTS At baseline, we found no major differences in overall performance of APPs compared with physicians (P = .337). APPs performed 3.2% better in history taking (P = .013) and made 10.5% fewer unnecessary referrals (P = .025), whereas physicians ordered 17.6% fewer low-value tests per case (P = .042). Regardless of specialty or site, after 4 rounds of serial measurement and provider-specific feedback, APPs and physicians had similar increases in average overall scores-7.4% and 7.6%, respectively (P < .001 for both). Not only did both groups improve, but practice differences between the groups disappeared, leading to a 9.1% decrease in overall practice variation. CONCLUSIONS We found only modest differences in quality of care provided by APPs and physicians. Importantly, both groups improved their performance with serial measurement and feedback so that after 4 rounds, the original differences were mitigated entirely and overall variation significantly reduced. Our data suggest that APPs can provide high quality care in multiple clinical settings.
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Affiliation(s)
| | | | | | | | | | | | | | - Brent Box
- AdventHealth, Altamonte Springs, Fla
| | | | - John Peabody
- QURE Healthcare, San Francisco, Calif; University of California, Los Angeles; Institute for Global Health Sciences, University of California, San Francisco.
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Woo BFY, Lee JXY, Tam WWS. The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: a systematic review. HUMAN RESOURCES FOR HEALTH 2017; 15:63. [PMID: 28893270 PMCID: PMC5594520 DOI: 10.1186/s12960-017-0237-9] [Citation(s) in RCA: 159] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/31/2017] [Indexed: 05/05/2023]
Abstract
BACKGROUND The prevalence of chronic illness and multimorbidity rises with population aging, thereby increasing the acuity of care. Consequently, the demand for emergency and critical care services has increased. However, the forecasted requirements for physicians have shown a continued shortage. Among efforts underway to search for innovations to strengthen the workforce, there is a heightened interest to have nurses in advanced practice participate in patient care at a great extent. Therefore, it is of interest to evaluate the impact of increasing the autonomy of nurses assuming advanced practice roles in emergency and critical care settings on patient outcomes. OBJECTIVES The objectives of this study are to present, critically appraise, and synthesize the best available evidence on the impact of advanced practice nursing on quality of care, clinical outcomes, patient satisfaction, and cost in emergency and critical care settings. REVIEW METHODS A comprehensive and systematic search of nine electronic databases and a hand-search of two key journals from 2006 to 2016 were conducted to identify studies evaluating the impact of advanced practice nursing in the emergency and critical care settings. Two authors were involved selecting the studies based on the inclusion criteria. Out of the original search yield of 12,061 studies, 15 studies were chosen for appraisal of methodological quality by two independent authors and subsequently included for analysis. Data was extracted using standardized tools. RESULTS Narrative synthesis was undertaken to summarize and report the findings. This review demonstrates that the involvement of nurses in advanced practice in emergency and critical care improves the length of stay, time to consultation/treatment, mortality, patient satisfaction, and cost savings. CONCLUSIONS Capitalizing on nurses in advanced practice to increase patients' access to emergency and critical care is appealing. This review suggests that the implementation of advanced practice nursing roles in the emergency and critical care settings improves patient outcomes. The transformation of healthcare delivery through effective utilization of the workforce may alleviate the impending rise in demand for health services. Nevertheless, it is necessary to first prepare a receptive context to effect sustainable change.
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Affiliation(s)
- Brigitte Fong Yeong Woo
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597 Singapore
| | - Jasmine Xin Yu Lee
- National University Heart Centre Singapore, National University Hospital, 5 Lower Kent Ridge Road, Main Building 1, Level 2, Singapore, 119074 Singapore
| | - Wilson Wai San Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597 Singapore
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Pozo-Martin F, Nove A, Lopes SC, Campbell J, Buchan J, Dussault G, Kunjumen T, Cometto G, Siyam A. Health workforce metrics pre- and post-2015: a stimulus to public policy and planning. HUMAN RESOURCES FOR HEALTH 2017; 15:14. [PMID: 28202047 PMCID: PMC5312527 DOI: 10.1186/s12960-017-0190-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 02/09/2017] [Indexed: 05/19/2023]
Abstract
BACKGROUND Evidence-based health workforce policies are essential to ensure the provision of high-quality health services and to support the attainment of universal health coverage (UHC). This paper describes the main characteristics of available health workforce data for 74 of the 75 countries identified under the 'Countdown to 2015' initiative as accounting for more than 95% of the world's maternal, newborn and child deaths. It also discusses best practices in the development of health workforce metrics post-2015. METHODS Using available health workforce data from the Global Health Workforce Statistics database from the Global Health Observatory, we generated descriptive statistics to explore the current status, recent trends in the number of skilled health professionals (SHPs: physicians, nurses, midwives) per 10 000 population, and future requirements to achieve adequate levels of health care in the 74 countries. A rapid literature review was conducted to obtain an overview of the types of methods and the types of data sources used in human resources for health (HRH) studies. RESULTS There are large intercountry and interregional differences in the density of SHPs to progress towards UHC in Countdown countries: a median of 10.2 per 10 000 population with range 1.6 to 142 per 10 000. Substantial efforts have been made in some countries to increase the availability of SHPs as shown by a positive average exponential growth rate (AEGR) in SHPs in 51% of Countdown countries for which there are data. Many of these countries will require large investments to achieve levels of workforce availability commensurate with UHC and the health-related sustainable development goals (SDGs). The availability, quality and comparability of global health workforce metrics remain limited. Most published workforce studies are descriptive, but more sophisticated needs-based workforce planning methods are being developed. CONCLUSIONS There is a need for high-quality, comprehensive, interoperable sources of HRH data to support all policies towards UHC and the health-related SDGs. The recent WHO-led initiative of supporting countries in the development of National Health Workforce Accounts is a very promising move towards purposive health workforce metrics post-2015. Such data will allow more countries to apply the latest methods for health workforce planning.
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Affiliation(s)
- Francisco Pozo-Martin
- Instituto de Cooperación Social Integrare, calle Balmes 30, 3-1, 08007, Barcelona, Spain
| | - Andrea Nove
- Instituto de Cooperación Social Integrare, calle Balmes 30, 3-1, 08007, Barcelona, Spain.
| | - Sofia Castro Lopes
- Instituto de Cooperación Social Integrare, calle Balmes 30, 3-1, 08007, Barcelona, Spain
| | - James Campbell
- Health Systems and Innovations, WHO Headquarters, Geneva, Switzerland
- Global Health Workforce Network, WHO Headquarters, Geneva, Switzerland
| | - James Buchan
- School of Nursing Midwifery and Health, University of Technology Sydney, Sydney, Australia
| | - Gilles Dussault
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Teena Kunjumen
- Health Systems and Innovations, WHO Headquarters, Geneva, Switzerland
| | - Giorgio Cometto
- Global Health Workforce Network, WHO Headquarters, Geneva, Switzerland
| | - Amani Siyam
- Health Systems and Innovations, WHO Headquarters, Geneva, Switzerland
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Kuhlmann E, Lauxen O, Larsen C. Regional health workforce monitoring as governance innovation: a German model to coordinate sectoral demand, skill mix and mobility. HUMAN RESOURCES FOR HEALTH 2016; 14:71. [PMID: 27894307 PMCID: PMC5127055 DOI: 10.1186/s12960-016-0170-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 11/22/2016] [Indexed: 05/07/2023]
Abstract
BACKGROUND As health workforce policy is gaining momentum, data sources and monitoring systems have significantly improved in the European Union and internationally. Yet data remain poorly connected to policy-making and implementation and often do not adequately support integrated approaches. This brings the importance of governance and the need for innovation into play. CASE The present case study introduces a regional health workforce monitor in the German Federal State of Rhineland-Palatinate and seeks to explore the capacity of monitoring to innovate health workforce governance. The monitor applies an approach from the European Network on Regional Labour Market Monitoring to the health workforce. The novel aspect of this model is an integrated, procedural approach that promotes a 'learning system' of governance based on three interconnected pillars: mixed methods and bottom-up data collection, strong stakeholder involvement with complex communication tools and shared decision- and policy-making. Selected empirical examples illustrate the approach and the tools focusing on two aspects: the connection between sectoral, occupational and mobility data to analyse skill/qualification mixes and the supply-demand matches and the connection between monitoring and stakeholder-driven policy. CONCLUSION Regional health workforce monitoring can promote effective governance in high-income countries like Germany with overall high density of health workers but maldistribution of staff and skills. The regional stakeholder networks are cost-effective and easily accessible and might therefore be appealing also to low- and middle-income countries.
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Affiliation(s)
- E. Kuhlmann
- Institute for Economics, Labour and Culture, Goethe University Frankfurt, Frankfurt, Germany
- Medical Management Centre, LIME, Karolinska Institutet, Stockholm, Sweden
| | - O. Lauxen
- Institute for Economics, Labour and Culture, Goethe University Frankfurt, Frankfurt, Germany
| | - C. Larsen
- Institute for Economics, Labour and Culture, Goethe University Frankfurt, Frankfurt, Germany
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Lopes MA, Almeida ÁS, Almada-Lobo B. Forecasting the medical workforce: a stochastic agent-based simulation approach. Health Care Manag Sci 2016; 21:52-75. [DOI: 10.1007/s10729-016-9379-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 08/22/2016] [Indexed: 10/21/2022]
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Why we need multi-level health workforce governance: Case studies from nursing and medicine in Germany. Health Policy 2015; 119:1636-44. [DOI: 10.1016/j.healthpol.2015.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 08/06/2015] [Accepted: 08/08/2015] [Indexed: 10/23/2022]
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Lopes MA, Almeida ÁS, Almada-Lobo B. Handling healthcare workforce planning with care: where do we stand? HUMAN RESOURCES FOR HEALTH 2015; 13:38. [PMID: 26003337 PMCID: PMC4464124 DOI: 10.1186/s12960-015-0028-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 05/02/2015] [Indexed: 05/21/2023]
Abstract
BACKGROUND Planning the health-care workforce required to meet the health needs of the population, while providing service levels that maximize the outcome and minimize the financial costs, is a complex task. The problem can be described as assessing the right number of people with the right skills in the right place at the right time, to provide the right services to the right people. The literature available on the subject is vast but sparse, with no consensus established on a definite methodology and technique, making it difficult for the analyst or policy maker to adopt the recent developments or for the academic researcher to improve such a critical field. METHODS We revisited more than 60 years of documented research to better understand the chronological and historical evolution of the area and the methodologies that have stood the test of time. The literature review was conducted in electronic publication databases and focuses on conceptual methodologies rather than techniques. RESULTS Four different and widely used approaches were found within the scope of supply and three within demand. We elaborated a map systematizing advantages, limitations and assumptions. Moreover, we provide a list of the data requirements necessary to implement each of the methodologies. We have also identified past and current trends in the field and elaborated a proposal on how to integrate the different methodologies. CONCLUSION Methodologies abound, but there is still no definite approach to address HHR planning. Recent literature suggests that an integrated approach is the way to solve such a complex problem, as it combines elements both from supply and demand, and more effort should be put in improving that proposal.
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Affiliation(s)
- Mário Amorim Lopes
- INESC TEC, Faculdade de Engenharia, Universidade do Porto, Porto, Portugal.
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Nancarrow SA. Six principles to enhance health workforce flexibility. HUMAN RESOURCES FOR HEALTH 2015; 13:9. [PMID: 26264184 PMCID: PMC4532254 DOI: 10.1186/1478-4491-13-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 01/22/2015] [Indexed: 05/29/2023]
Abstract
UNLABELLED This paper proposes approaches to break down the boundaries that reduce the ability of the health workforce to respond to population needs, or workforce flexibility. Accessible health services require sufficient numbers and types of skilled workers to meet population needs. However, there are several reasons that the health workforce cannot or does not meet population needs. These primarily stem from workforce shortages. However, the health workforce can also be prevented from responding appropriately and efficiently because of restrictions imposed by professional boundaries, funding models or therapeutic partitions. These boundaries limit the ability of practitioners to effectively diagnose and treat patients by restricting access to specific skills, technologies and services. In some cases, these boundaries not only reduce workforce flexibility, but they introduce inefficiencies in the form of additional clinical transactions and costs, further detracting from workforce responsiveness. Several new models of care are being developed to enhance workforce flexibility by enabling existing staff to work to their full scope of practice, extend their roles or by introducing new workers. Expanding on these concepts, this theoretical paper proposes six principles that have the potential to enhance health workforce flexibility, specifically: 1. Measure health system performance from the perspective of the patient. 2. Minimise training times. 3. Regulate tasks (competencies), not professions. 4. Match rewards and indemnity to the levels of skill and risk required to perform a particular task, not professional title. 5. Ensure that practitioners have all the skills they need to perform the tasks required to work in the environment in which they work 6. Enable practitioners to work to their full scope of practice delegate tasks where required These proposed principles will challenge some of the existing social norms around health-care delivery; however, many of these principles are already being applied, albeit on a small scale. This paper discusses the implications of these reforms. PROPOSED DISCUSSION POINTS 1. Is person-centred care at odds with professional monopolies? 2. Should the state regulate professions and, by doing so, protect professional monopolies or, instead, regulate tasks or competencies? 3. Can health-care efficiency be enhanced by reducing the number of clinical transactions required to meet patient needs?
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Affiliation(s)
- Susan A Nancarrow
- School of Health and Human Sciences, Southern Cross University, East Lismore, NSW, 2480, Australia.
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