Handling healthcare workforce planning with care: where do we stand?

Maintaining health service during COVID-19: A study on regional health services

The pandemic has inevitably led to disruptions in the provision of health services for all those patients not affected by COVID-19. At the same time, we have observed differences among health services in their ability to maintain their activities in the face of shocks: while some health services were largely able to ensure core functions, other suffered delays in prevention, acute care, and rehabilitation. In this paper, we explore the effect of regional health policies in terms of governance, workforce, and health service delivery on the ability to maintain oncological services during the COVID-19 pandemic to assess the resilience of the system. The study is based on secondary data collected on the 21 Italian regional health services during the first wave of the pandemic. We discuss the theoretical and practical implications of providing health services with specific characteristics pertaining to governance, workforce, and health service delivery to support the resilience of regional health policies during a crisis or shock.

The Australian health workforce: Disproportionate shortfalls in small rural towns

INTRODUCTION

The distribution of health care workers differs greatly across Australia, which is likely to impact health delivery.

OBJECTIVE

To examine demographic and workplace setting factors of doctors, nurses and midwives, and allied health professionals across Modified Monash Model (MMM) regions and identify factors associated with shortfalls in the health care workforce.

DESIGN

Descriptive cross-sectional analysis. The study included all health professionals who were registered with the Australian Health Practitioner Regulation Agency in 2021, and who were working in Australia in their registered profession. The study examined number of registrations and full-timed equivalent (FTE) registrations per MMM region classification, adjusted for population. Associated variables included age, gender, origin of qualification, Indigenous status and participation in the private or public (including government, non-government organisation and not-for-profit organisations) sectors.

FINDINGS

Data were available for 31 221 general practitioners, 77 277 other doctors, 366 696 nurses and midwives, and 195 218 allied health professionals. The lowest FTE per 1000 people was seen in MM5 regions for general practitioners, other doctors, nurses and midwives, and allied health professionals. Demographic factors were mostly consistent across MM regions, although MM5 regions had a higher percentage of nurses and midwives and allied health professionals aged 55 and over. In the private sector, FTE per 1000 people was lowest in MM5-7 regions. In the public sector, FTE per 1000 people was lowest in MM5 regions.

DISCUSSION

A disproportionate shortfall of health workers was seen in MM5 regions. This shortfall appears to be primarily due to low FTE per capita of private sector workers compared with MM1-4 regions and a low FTE per capita of public sector workers compared with MM6-7 regions.

CONCLUSION

In Australia, small rural towns have the lowest number of health care workers per capita which is likely to lead to poor health outcomes for those regions.

Methods for health workforce projection model: systematic review and recommended good practice reporting guideline

BACKGROUND

Health workforce projection models are integral components of a robust healthcare system. This research aims to review recent advancements in methodology and approaches for health workforce projection models and proposes a set of good practice reporting guidelines.

METHODS

We conducted a systematic review by searching medical and social science databases, including PubMed, EMBASE, Scopus, and EconLit, covering the period from 2010 to 2023. The inclusion criteria encompassed studies projecting the demand for and supply of the health workforce. PROSPERO registration: CRD 42023407858.

RESULTS

Our review identified 40 relevant studies, including 39 single countries analysis (in Australia, Canada, Germany, Ghana, Guinea, Ireland, Jamaica, Japan, Kazakhstan, Korea, Lesotho, Malawi, New Zealand, Portugal, Saudi Arabia, Serbia, Singapore, Spain, Thailand, UK, United States), and one multiple country analysis (in 32 OECD countries). Recent studies have increasingly embraced a complex systems approach in health workforce modelling, incorporating demand, supply, and demand-supply gap analyses. The review identified at least eight distinct types of health workforce projection models commonly used in recent literature: population-to-provider ratio models (n = 7), utilization models (n = 10), needs-based models (n = 25), skill-mixed models (n = 5), stock-and-flow models (n = 40), agent-based simulation models (n = 3), system dynamic models (n = 7), and budgetary models (n = 5). Each model has unique assumptions, strengths, and limitations, with practitioners often combining these models. Furthermore, we found seven statistical approaches used in health workforce projection models: arithmetic calculation, optimization, time-series analysis, econometrics regression modelling, microsimulation, cohort-based simulation, and feedback causal loop analysis. Workforce projection often relies on imperfect data with limited granularity at the local level. Existing studies lack standardization in reporting their methods. In response, we propose a good practice reporting guideline for health workforce projection models designed to accommodate various model types, emerging methodologies, and increased utilization of advanced statistical techniques to address uncertainties and data requirements.

CONCLUSIONS

This study underscores the significance of dynamic, multi-professional, team-based, refined demand, supply, and budget impact analyses supported by robust health workforce data intelligence. The suggested best-practice reporting guidelines aim to assist researchers who publish health workforce studies in peer-reviewed journals. Nevertheless, it is expected that these reporting standards will prove valuable for analysts when designing their own analysis, encouraging a more comprehensive and transparent approach to health workforce projection modelling.

Forecasting the Early Impact of COVID-19 on Physician Supply in EU Countries

BACKGROUND

Many countries faced health workforce challenges even before the pandemic, such as impending retirements, negative population growth, or sub-optimal allocation of resources across health sectors. Current quantitative models are often of limited use, either because they require extensive individual-level data to be properly calibrated, or (in the absence of such data) because they are too simplistic to capture important demographic changes or disruptive epidemiological shocks such as the SARS-CoV-2 pandemic.

METHODS

We propose a population-dynamic and stock-flow-consistent approach to physician supply forecasting that is complex enough to account for dynamically changing behaviour, while requiring only publicly available time-series data for full calibration. We demonstrate the utility of this model by applying it to 21 European countries to forecast the supply of generalist and specialist physicians to 2040, and the impact of increased healthcare utilisation due to COVID-19 on this supply.

RESULTS

Compared with the workforce needed to maintain physician density at 2019 levels, we find that in many countries there is indeed a significant trend towards decreasing generalist density at the expense of increasing specialist density. The trends for specialists are exacerbated by expectations of negative population growth in many Southern and Eastern European countries. Compared to the expected demographic changes in the population and the health workforce, we expect a limited impact of COVID-19 on these trends, even under conservative modelling assumptions. Finally, we generalise the approach to a multi-professional, multi-regional and multi-sectoral model for Austria, where we find an additional suboptimal distribution in the supply of contracted versus non-contracted (private) physicians.

CONCLUSION

It is therefore vital to develop tools for decision-makers to influence the allocation and supply of doctors across specialties and sectors to address these imbalances.

Transforming health care systems towards high-performance organizations: qualitative study based on learning from COVID-19 pandemic in the Basque Country (Spain)

BACKGROUND

The COVID-19 pandemic is one of the worst health catastrophes of the last century, which caused severe economic, political, and social consequences worldwide. Despite these devastating consequences, lessons learned provide a great opportunity that can drive the reform of health systems to become high-performing, effective, equitable, accessible, and sustainable organisations. This work identifies areas in which changes must be encouraged that will enable health systems to deal effectively with current and future challenges, beyond COVID-19.

METHODS

A realist design was chosen, based on qualitative data collection techniques, content analysis and triangulation to identify key domains of organizational interventions behind the changes implemented to react to the COVID-19 pandemic in the Basque Country. Twenty key informants were used as an expert source of information. Thematic analysis was done using the Framework Method.

RESULTS

The analysis of the interviews resulted in the identification of 116 codes, which were reviewed and agreed upon by the researchers. Following the process of methodological analysis, these codes were grouped into domains: seven themes and 23 sub-themes. Specifically, the themes are: responsiveness, telehealth, integration, knowledge management, professional roles, digitisation, and organisational communication. The detailed description of each theme and subtheme is presented.

CONCLUSIONS

The findings of this work pretend to guide the transformation of health systems into organisations that can improve the health of their populations and provide high quality care. Such a multidimensional and comprehensive reform encompasses both strategic and operational actions in diverse areas and requires a broad and sustained political, technical, and financial commitment.

Experiences and learnings from developing and implementing a co-designed value-based healthcare framework within Victorian public oral health sector

Objective This study aimed to describe the development and implementation of a co-designed value-based healthcare (VBHC) framework within the public dental sector in Victoria. Methods A mixed-method study was employed. Explorative qualitative design was used to examine patient, workforce and stakeholder perspectives of implementing VBHC. Participatory action research was used to bring together qualitative narrative-based research and service design methods. An experience-based co-design approach was used to enable staff and patients to co-design services. Quantitative data was sourced from Titanium (online patient management system). Results Building a case for VBHC implementation required intensive work. It included co-designing, collaborating, planning and designing services based on patient needs. Evidence reviews, value-stream mapping and development of patient reported outcomes (PROMs) and patient reported experience measures (PREMs) were fundamental to VBHC implementation. Following VBHC implementation, a 44% lower failure to attend rate and 60% increase in preventive interventions was reported. A higher proportion of clinicians worked across their top scope of practice within a multi-disciplinary team. Approximately 80% of services previously provided by dentists were shifted to oral health therapists and dental assistants, thereby releasing the capacity of dentists to undertake complex treatments. Patients completed baseline International Consortium for Health Outcomes Measurement PROMs (n  = 44,408), which have been used for social/clinical triaging, determining urgency of care based on risk, segmentation and tracking health outcomes. Following their care, patients completed a PREMs questionnaire (n  = 15,402). Patients agreed or strongly agreed that: the care they received met their needs (87%); they received clear answers to their questions (93%); they left their visit knowing what is next (91%); they felt taken care of during their visit (94%); and they felt involved in their treatment and care (94%). Conclusion The potential for health system transformation through implementation of VBHC is significant, however, its implementation needs to extend beyond organisational approaches and focus on sustaining the principles of VBHC across healthcare systems, policy and practice.

Barriers and facilitators to the implementation of an early intervention in psychosis service in three demonstration sites in Ireland

BACKGROUND

Programmes for early intervention (EIP) in psychosis for people experiencing a first episode of psychosis (FEP) have been found to be both clinically and cost effective. Following the publication of a new EIP model of care (MoC) in Ireland, the aim of this research is to describe how people participated in and responded to the MoC including service users, family members, HSE clinical staff and HSE management.

METHODS

Qualitative design using the UK Medical Research Council's process evaluation framework. Purposive sampling techniques were used. A total of N = 40 key informant semi-structured interviews were completed which included clinical staff (N = 22), health service managers and administrators (N = 9), service users (N = 8) and a family member (N = 1). Thematic analyses were conducted.

RESULTS

Unique features of the EIP service (e.g., speed of referral/assessment, multidisciplinary approach, a range of evidence-based interventions and assertive MDT follow up) and enthusiasm for EIP were identified as two key factors that facilitated implementation. In contrast, obstacles to staff recruitment and budget challenges emerged as two primary barriers to implementation.

CONCLUSIONS

The findings from this research provide real world insights into the complexity of implementing an innovative service within an existing health system. Clear and committed financial and human resource processes which allow new innovations to thrive and be protected during their initiation and early implementation phase are paramount. These elements should be considered in the planning and implementation of EIP services both nationally in Ireland and internationally.

Employment Rate of Newly Certified Healthcare Specialists in Saudi Arabia: A Survey-Based Study

Background This study aimed to assess and compare the employment rates of medical and dental specialists across different regions of Saudi Arabia from 2011 to 2019. Methodology With the aid of the Saudi Commission for Health Specialties, the national survey was sent via email to 12,000 healthcare postgraduates who obtained their board certificate within the period 2011-2019. It contained several questions regarding demographics, specialty, employment, satisfaction, and, finally, challenges and obstacles they faced during their job-seeking experience. Results Of the 723 respondents, almost 655 (90.7%) were employed. The employment rate of medical specialists (n = 605, 90.7%) was higher than dental specialists (n = 50, 89.3%). Nevertheless, 96% (n = 48) of dental employees were working at a specialty of their specified qualification, while only 93.7% (n = 562) of medical employees did. Regarding the month of their employment, the month of October (15.25%) had the highest employment rate for medical specialists; however, for a dental specialist, August (18%) had the highest employment rate. However, 64.5% of the respondents admitted that they faced challenges during their job-seeking experience, with few available positions being the most common obstacle for both medical and dental specialists. Conclusions Our survey confirms that medical and dental specialists in Saudi Arabia are facing delays in entering the workforce, which vary by region and specialty. It also sheds light on the reasons for these gaps, with limited job opportunities being a major issue for both groups. For career advancement, it is essential to identify these obstacles and develop a strategy to overcome them, such as involving the private sector.

Methods and Tools Used to Estimate the Shortages of Medical Staff in European Countries-Scoping Review

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.

The World Health Organization targets for cervical cancer control by 2030: a baseline assessment in six African countries-part I

Aim

We present and analyse the findings of a survey of the readiness of the healthcare systems in Eswatini, Guinea, Malawi, Rwanda, Uganda and Zambia, to implement the necessary measures for attaining the targets for cervical cancer control, set by The World Health Organization (WHO), by the year 2030.

Methods

A questionnaire with 129 questions with preset answer options was completed in 2020, by ministries of health programme coordinators for non-communicable diseases, cancer control and/or reproductive health, and by WHO country offices, in the six countries selected.

Results

The findings on demographics, burden of disease, governance and management, laboratory services, equipment, supplies and medicines, as well as on personnel and training are presented here. The burden of cervical cancer in the countries studied is considerable, according to The International Agency for Research on Cancer estimations. The incidence of the disease is augmented by the high prevalence of HIV infection, in most of the countries surveyed. Most of the population live in rural areas, where access to the health services is far from ideal. Facilities for screening with human papilloma virus tests and for histopathology are limited. One pathologist covers the diagnostic needs of between 0.5 and 4 million inhabitants. Most other categories of health professionals are under-represented, and the capacity to train them is inadequate.

Conclusions

Strong country commitment and leadership, innovative solutions and extensive international cooperation would be needed to attain the targets of cervical cancer control set by WHO, in these countries.

Health workforce supply, needs and financial feasibility in Lesotho: a labour market analysis

BACKGROUND

The Government of Lesotho has prioritised health investment that aims to improve the health and socioeconomic development of the country, including the scaling up of the health workforce (HWF) training and improving their working conditions. Following a health labour market analysis, the paper highlights the available stock of health workers in Lesotho's health labour market, 10-year projected supply versus needs and the financial implications.

METHODS

Multiple complementary approaches were used to collect data and analyse the HWF situation and labour market dynamics. These included a scooping assessment, desk review, triangulation of different data sources for descriptive analysis and modelling of the HWF supply, need and financial space.

FINDINGS

Lesotho had about 20 942 active health workers across 18 health occupations in 2020, mostly community health workers (69%), nurses and midwives (17.9%), while medical practitioners were 2%. Almost one out of three professional nurses and midwives (28.43%) were unemployed, and nearly 20% of associate nurse professionals, 13.26% of pharmacy technicians and 24.91% of laboratory technicians were also unemployed. There were 20.73 doctors, nurses and midwives per 10 000 population in Lesotho, and this could potentially increase to a density of 31.49 doctors, nurses and midwives per 10 000 population by 2030 compared with a need of 46.72 per 10 000 population by 2030 based on projected health service needs using disease burden and evolving population size and demographics. The existing stock of health workers covered only 47% of the needs and could improve to 55% in 2030. The financial space for the HWF employment was roughly US$40.94 million in 2020, increasing to about US$66.69 million by 2030. In comparison, the cost of employing all health workers already in the supply pipeline (in addition to the currently employed ones) was estimated to be US$61.48 million but could reach US$104.24 million by 2030. Thus, a 33% gap is apparent between the financial space and what is required to guarantee employment for all health workers in the supply pipeline.

CONCLUSION

Lesotho's HWF stock falls short of its population health need by 53%. The unemployment of some cadres is, however, apparent. Addressing the need requires increasing the HWF budget by at least 12.3% annually up to 2030 or prioritising at least 33% of its recurrent health expenditure to the HWF.

Planning human resources and facilities to achieve Sustainable Development Goals: a decision-analytical modelling approach to predict cancer control requirements in Indonesia

Objectives

Indonesia aims to achieve universal health coverage (UHC) and Sustainable Development Goals (SDGs), including SDG 3 target 4, which focuses on cancer control, by 2030. This study aimed to forecast the human resources for health (HRH) and facilities required for cancer control in Indonesia over an 11-year period to support these goals.

Design

A two-stage Markov model was developed to forecast the demand side of facilities and HRH requirements for cancer control in Indonesia over an 11-year period.

Setting

Data sources used include the Indonesia Health Profile Report (2019), the Indonesian Radiation Oncology Society Database and National Cancer Control Committee documents (2019).

Methods

The study involved modelling the current availability of HRH and healthcare facilities in Indonesia and predicting future requirements. The gap between the current and the required HRH and facilities related to oncology, and the costs associated with meeting these requirements, were analysed.

Results

Results indicate the need to increase the number of healthcare facilities and HRH to achieve SDG targets. However, UHC for cancer care still may not be achieved, as eastern Indonesia is predicted to have no tertiary hospital until 2030. The forecast shows that Indonesia had a median of only 39% of the HRH requirements in 2019. Closing the HRH gap requires around a 47.6% increase in salary expenditure.

Conclusion

This study demonstrates the application of decision-analytical modelling approach to planning HRH and facilities in the context of a low-to-middle-income country. Scaling up oncology services in Indonesia to attain the SDG targets will require expansion of the number and capability of healthcare facilities and HRH. This work allows an in-depth understanding of the resources needed to achieve UHC and SDGs and could be utilised in other disease areas and contexts.

Physician turnover in primary health care services in the East Zone of São Paulo City, Brazil: incidence and associated factors

BACKGROUND

The shortage and high turnover of physicians is a recurrent problem in health care systems; this is especially harmful to the expansion and full operation of primary health care (PHC). The aim of this paper is to analyze incidence and associated factors with physician turnover in primary health care services in the East Zone of São Paulo City.

METHODS

This is a retrospective cohort study of 1378 physicians over a 15 years' time period based on physicians' administrative records from two distinct secondary databases. Physicians' individual characteristics were analyzed including graduation and specialization. Survival analysis techniques such Kaplan-Meier and Cox Regression were used to analyze the termination of contract.

RESULTS

One thousand three hundred seventy-eight physicians were included in the study of which 130 [9.4%(CI95 8.0-11.1%)] remained in the PHC services. The mean and median time until the occurrence of the physician leaving the service was 2.14 years (CI95% 1.98-2.29 years) and 1.17 years [(CI95% 1.05-1.28 years)]. The probability of contract interruption was 45% in the first year and 68% in the second year. Independent factors associated with TEC were identified: workload of 40 h/week HR = 1.71 [(CI95% 1.4-2.09), p < 0.001]; initial salary ≤1052 BGI HR = 1.87 [(CI95 1.64-2.15), p < 0.001]; time since graduation ≤2 years HR =1.36 [(CI95 1.18-1.56), p < 0.001]; and the conclusion of residency in up to 3 years after leaving the service HR = 1.69 [(CI95 1.40-2.04), p < 0.001].

CONCLUSIONS

The time of employment of the physician in PHC was relatively short, with a high probability of TEC in the first year. Modifiable factors such as working hours, starting salary, time since graduation from medical school and need to enter in a residency program were associated with TEC. In pointing out that modifiable factors are responsible for long term employment or the end of contract of physicians in PHC services of the Unified Health System in the periphery of a metropolitan area, the study provides support for the planning, implementation and management of policies and strategies aimed at attracting and retaining physicians in suburban, priority or underserved regions.

Lessons learned from implementation of the Workload Indicator of Staffing Need (WISN) methodology: an international Delphi study of expert users

BACKGROUND

Staffing of health services ought to consider the workload experienced to maximize efficiency. However, this is rarely the case, due to lack of an appropriate approach. The World Health Organization (WHO) developed and has promoted the Workload Indicators of Staffing Need (WISN) methodology globally. Due to its relative simplicity compared to previous methods, the WISN has been used extensively, particularly after its computerization in 2010. Many lessons have been learnt from the introduction and promotion of the methodology across the globe but have, hitherto, not been synthesized for technical and policy consideration. This study gathered, synthesized, and now shares the key adaptations, innovations, and lessons learned. These could facilitate lesson-learning and motivate the WHO's WISN Thematic Working Group to review and further ease its application.

METHODS

The study aimed to answer four questions: (1) how easy is it for the users to implement each step of the WISN methodology? (2) What innovations have been used to overcome implementation challenges? (3) What lessons have been learned that could inform future WISN implementation? and (4) what recommendations can be made to improve the WISN methodology? We used a three-round traditional Delphi method to conduct a case study of user-experiences during the adoption of the WISN methodology. We sent three email iterations to 23 purposively selected WISN expert users across 21 countries in five continents. Thematic analysis of each round was done simultaneously with data collection.

RESULTS

Participants rated seven of the eight technical steps of the WISN as either "very easy" or "easy" to implement. The step considered most difficult was obtaining the Category Allowance Factors (CAF). Key lessons learned were that: the benefits gained from applying the WISN outweigh the challenges faced in understanding the technical steps; benchmarking during WISN implementation saves time; data quality is critical for successful implementation; and starting with small-scale projects sets the ground better for more effective scale-up than attempting massive national application of the methodology the first time round.

CONCLUSIONS

The study provides a good reference for easing WISN implementation for new users and for WHO to continue promoting and improving upon it.

Are return-of-service bursaries an effective investment to build health workforce capacity? A qualitative study of key South African policymakers

Return-of-service schemes (RoS) or bursaries are used in South Africa and other nations to publicly fund the training of skilled health professionals in return for the beneficiary agreeing to return to serve in their local provinces on a year-for-year basis. This study aimed to understand insights of key policymakers in South African provinces to identify barriers and solutions to implementation of RoS schemes used to recruit and retain skilled health professionals. This research draws on the insights of 16 key South African policymakers from eight of its nine provinces through semi-structured, qualitative interviews. The respondents were interviewed through Microsoft Teams virtual platform, either in pairs (ten) or as individuals (six). Data were analysed using inductive, thematic analysis in NVIVO. The study was reported according to the consolidated criteria for reporting qualitative research. Respondents reported that the schemes had resulted in an increase in the number of skilled health professionals and had provided opportunities for study and employment for previously marginalised groups. Formal evaluations of the impact of the schemes were not reported, however, a number of shortcomings with current schemes were identified that were likely limiting their effectiveness. Respondents reported a lack of foresight in the scheme implementation including a bias in the selection of beneficiaries towards medical professionals at the expense of other health workers. Furthermore, failure to plan for practice location when beneficiaries finished training limited the capacity of the schemes to meet the needs of local populations. Monitoring of recipients was limited by loopholes in contract design, decision-making and poor coordination between departments. Between 1 and 30% of beneficiaries were reported to default their contracts with some not completing their studies, some not returning after completing their internship and others terminating their services before concluding their contracts. Return-of-service schemes have helped in overcoming health professional shortages. However, they haven't been formally evaluated. Several planning and implementation shortcomings were identified which can be improved to enhance access to healthcare in South Africa.

The Nurse Practitioner Workforce in Western Canada: A Cross-Sectional Practice Analysis Comparison

Regular examination of health workforce data is essential given the pace of health system and legislative changes. Health workforce studies pertaining to nurse practitioner (NP) practice are needed to examine the gaps between work activities, policy, human resource supply, or for population needs. Jurisdictional comparison studies can provide essential information about NP practice for governments to respond to health workforce deficiencies or engage in service planning. In Canada, there is limited provincial-territorial jurisdictional NP workforce data to support health planning or policy change. This descriptive cross-sectional study was to examine the similarities and differences in practice patterns of Canadian NPs. In 2016 and 2017, an electronic survey was sent to all 852 registered NPs in three Canadian provinces, yielding a large convenience sample of 375 NP respondents. The results of this study underscore the value of NPs’ extensive registered nurse expertize as well as their ability to serve diverse patient populations, work in varied healthcare settings, and provide care to medically complex patients. The study findings also show that NPs in all three jurisdictions work to their full scope of practice, in both rural and urban settings. This study is the first to compare NP workforce data across multiple Canadian jurisdictions simultaneously. Studies of this type are valuable tools for understanding the demographics, education, integration, and employment activities of NPs and can aid governments in addressing workforce planning.

Determining diagnostic radiographer staffing requirements: A workload-based approach

INTRODUCTION

The topic of healthcare human resource planning for diagnostic radiographers has received limited research attention to date. This research is concerned with developing a framework that can be used to determine diagnostic radiographer staffing requirements at a unit- or department level (i.e. at the micro-level).

METHODS

An inductive approach is applied to formulate requirement specifications that inform the development of the framework. A number of verification and validation activities are performed, including theoretical verification and a case study application.

RESULTS

The diagnostic radiographer staffing framework consists of seven steps that comprise a workload-based approach to determining the number of full time equivalent diagnostic radiographers that are required for each modality, or group of modalities. Both clinical and non-clinical activities are considered, and guidance is provided on calculating staffing requirements to cover leave allowances. A number of potential approaches to determining activity times are also discussed.

CONCLUSION

The framework represents a holistic approach to determining the required number of diagnostic radiographers at a practice-level, that is designed to remain relevant as technological advances are made in the field of diagnostic radiography.

IMPLICATIONS FOR PRACTICE

By providing a practical guideline, with accompanying examples, the framework is expected to hold value for individuals involved in the management of diagnostic radiography practices. The framework proposes an approach to a topic that affects every radiography practice in operation yet has received limited attention in literature to date.

Modelling the supply and need for health professionals for primary health care in Ghana: Implications for health professions education and employment planning

Background

The health workforce (HWF) is critical in developing responsive health systems to address population health needs and respond to health emergencies, but defective planning have arguably resulted in underinvestment in health professions education and decent employment. Primary Health Care (PHC) has been the anchor of Ghana’s health system. As Ghana’s population increases and the disease burden doubles, it is imperative to estimate the potential supply and need for health professionals; and the level of investment in health professions education and employment that will be necessary to avert any mismatches.

Methods

Using a need-based health workforce planning framework, we triangulated data from multiple sources and systematically applied a previously published Microsoft® Excel-based model to conduct a fifteen-year projection of the HWF supply, needs, gaps and training requirements in the context of primary health care in Ghana.

Results

The projections show that based on the population (size and demographics), disease burden, the package of health services and the professional standards for delivering those services, Ghana needed about 221,593 health professionals across eleven categories in primary health care in 2020. At a rate of change between 3.2% and 10.7% (average: 5.5%) per annum, the aggregate need for health professionals is likely to reach 495,273 by 2035. By comparison, the current (2020) stock is estimated to grow from 148,390 to about 333,770 by 2035 at an average growth rate of 5.6%. The health professional’s stock is projected to meet 67% of the need but with huge supply imbalances. Specifically, the supply of six out of the 11 health professionals (~54.5%) cannot meet even 50% of the needs by 2035, but Midwives could potentially be overproduced by 32% in 2030.

Conclusion

Future health workforce strategy should endeavour to increase the intake of Pharmacy Technicians by more than seven-fold; General Practitioners by 110%; Registered general Nurses by 55% whilst Midwives scaled down by 15%. About US$ 480.39 million investment is required in health professions education to correct the need versus supply mismatches. By 2035, US$ 2.374 billion must be planned for the employment of those that would have to be trained to fill the need-based shortages and for sustaining the employment of those currently available.

Co-designing a methodology for workforce development during the personalisation of allied health service funding for people with disability in Australia

Background

Internationally, health and social services are undergoing creative and extensive redesign to meet population demands with rationed budgets. This has critical implications for the health workforces that serve such populations. Within the workforce literature, few approaches are described that enable workforce development for health professions in the service contexts that emerge from large scale service redesign in times of industry shift. We contribute an innovative and robust methodology for workforce development that was co-designed by stakeholders in allied health during the personalisation of disability funding in Australia (the introduction of the National Disability Insurance Scheme).

Methods

In the context of a broad action research project, we used program logic modelling to identify and enact opportunities for sustainable allied health education and workforce integration amidst the changed service provision context. We engaged with 49 industry stakeholders across 92 research engagements that included interviews (n = 43), a workshop explicitly for model development (n = 8) and a Project Advisory Group (n = 15). Data from these activities were inductively coded, analysed, and triangulated against each other. During the program logic modelling workshop, we worked with involved stakeholders to develop a conceptual model which could be used to guide trial and evaluation of allied health education which was fit-for-purpose to emerging workforce requirements.

Results

Stakeholder interviews showed that drivers of workforce design during industry shift were that (1) service provision was happening in turbulent times; (2) new concerns around skills and professional engagement were unfolding for AHP in the NDIS; and (3) impacts to AHP education were being experienced. The conceptual model we co-designed directly accounted for these contextual features by highlighting five underpinning principles that should inform methodologies for workforce development and AHP education in the transforming landscape: being (1) pedagogically sound; (2) person- or family-centred; (3) NDIS compliant; (4) informed by evidence and (5) having quality for all. We use a case study to illustrate how the co-designed conceptual model stimulated agility and flexibility in workforce and service redesign.

Conclusions

Proactive and situated education of the emerging workforce during policy shift is essential to realise future health workforces that can appropriately and effectively service populations under a variety of changing service and funding structures – as well as their transitions. We argue that collaborative program logic modelling in partnership with key stakeholders including existing workforce can be useful for broad purposes of workforce (re)design in diverse contexts.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06711-x.

The health workforce demand: a systematic literature review

Understanding imbalances between the supply and demand of the human resour- ces for health (HRH) is essential for enhancing health outcomes. Addressing the HRH demand is particularly challenging, especially given the deficit of accurate data and surplus of unresolved methodological flaws. This study presents a systematic review of the literature surrounding HRH demand and answers the following key questions: How has HRH demand been addressed? What are the harms and barriers that accompany HRH demand modeling? This systematic review was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) statement. Relevant keywords were used in a thorough search of the PubMed/MEDLINE, SCOPUS, and Web of Science databases. A total of 2,599 papers were retrieved and evaluated according to their title and abstract. Of these, the full-text of 400 papers was analyzed, 53 of which successfully met the inclusion criteria in our study. While the topic's relevance is widespread, it still lacks a validated approach to model HRH demand adequately. The main characteristics of the applied methods are presented, such as their application complexity by health policymakers. Opportunities and orientations for further research are also highlighted.

Oral Health System in Myanmar: A Review

Objectives:

The study aims at reviewing Myanmar’s current situation to consider an improved oral health system and at promoting the oral health status of the Myanmar population.

Materials and Methods:

This review was conducted using the World Health Organization’s (WHO’s) six building blocks of the health system: oral health-care service delivery, dental workforce, oral health information system, essential medicine, health financing, and leadership and governance. The review was established on scientific articles and documents and information from reliable government and nongovernment organizations’ websites.

Results:

According to the National Oral Health Survey (2016–2017), the prevalence rate of untreated caries in six-year-old Myanmar children (84.1%), and in the 35–44 and 65–74 age group (above 40%) is high, which reflects a low utilization of oral health-care services. The dentist to population ratio is approximately 1:16,000: There are around 5,000 dentists and 400 trained dental nurses in Myanmar, and only about 1,000 dentists serve in government sectors. The inequalities in dental health care are compounded by a limited dental workforce and inequality of dentists between the public and private sectors in Myanmar. In the last National Health Plan (NHP, 2006–2011), the Myanmar government’s funding for required dental equipment and materials in each dental unit (around 5726 USD) has been considered inadequate. The current expenditure is not transparent. The other challenges are an insufficient supply of dental materials and instruments to all public dental sectors and a lack of oral health-care infrastructure.

Conclusions:

Such findings suggest a pressing need to address the effective oral health-care system and decree the specific goals for the Myanmar population’s oral health.

Making a difference: workforce skills and capacity for integrated care

Purpose

The aim of this action research was to explore, from a workforce and a patient/carer perspective, the skills and the capacity required to deliver integrated care and to inform future workforce development and planning in a new integrated care system in England.

Design/methodology/approach

Semi-structured interviews and focus groups with primary, community, acute care, social care and voluntary care, frontline and managerial staff and with patients and carers receiving these services were undertaken. Data were explored using framework analysis.

Findings

Analysis revealed three overarching themes: achieving teamwork and integration, managing demands on capacity and capability and delivering holistic and user-centred care. An organisational development (OD) process was developed as part of the action research process to facilitate the large-scale workforce changes taking place.

Research limitations/implications

This study did not consider workforce development and planning challenges for nursing and care staff in residential, nursing care homes or domiciliary services. This part of the workforce is integral to the care pathways for many patients, and in line with the current emerging national focus on this sector, these groups require further examination. Further, data explore service users' and carers' perspectives on workforce skills. It proved challenging to recruit patient and carer respondents for the research due to the nature of their illnesses.

Practical implications

Many of the required skills already existed within the workforce. The OD process facilitated collaborative learning to enhance skills; however, workforce planning across a whole system has challenges in relation to data gathering and management. Ensuring a focus on workforce development and planning is an important part of integrated care development.

Social implications

This study has implications for social and voluntary sector organisations in respect of inter-agency working practices, as well as the identification of workforce development needs and potential for informing subsequent cross-sector workforce planning arrangements and communication.

Originality/value

This paper helps to identify the issues and benefits of implementing person-centred, integrated teamworking and the implications for workforce planning and OD approaches.

Health Service Activity Standards and Standard Workloads for Primary Healthcare in Ghana: A Cross-Sectional Survey of Health Professionals

The attainment of health system goals is largely hinged on the health workforce availability and performance; hence, health workforce planning is central to the health policy agenda. This study sought to estimate health service activity standards and standard workloads at the primary health care level in Ghana and explore any differences across health facility types. A nationally representative cross-sectional survey was conducted among 503 health professionals across eight health professions who provided estimates of health service activity standards in Ghana's Primary Health Care (PHC) settings. Outpatient consultation time was 16 min, translating into an annual standard workload of 6030 consultations per year for General Practitioners. Routine nursing care activities take an average of 40 min (95% CI: 38-42 min) for low acuity patients; and 135 min (95% CI: 127-144 min) for high dependency patients per inpatient day. Availability of tools/equipment correlated with reduced time on clinical procedure. Physician Assistants in health centres spend more time with patients than in district hospitals. Midwives spend 78 min more during vaginal delivery in health centres/polyclinics than in district/primary hospital settings. We identified 18.9% (12 out of 67) of health service activities performed across eight health professional groups to differ between health centres/polyclinics and district/primary hospitals settings. The workload in the health facilities was rated 78.2%, but as the workload increased, and without a commensurate increase in staffing, health professionals reduced the time spent on individual patient care, which could have consequences for the quality of care and patient safety. Availability of tools and equipment at PHC was rated 56.6%, which suggests the need to retool these health facilities. The estimated standard workloads lay a foundation for evidence-based planning for the optimal number of health professionals needed in Ghana's PHC system and the consequent adjustments necessary in both health professions education and the budgetary allocation for their employment. Finally, given similarity in results with Workload Indicators of Staffing Need (WISN) methodology used in Ghana, this study demonstrates that cross-sectional surveys can estimate health service activity standards that is suitable for health workforce planning just as the consensus-based estimates advocated in WISN.

The needs-based health workforce planning method: a systematic scoping review of analytical applications

Although the theoretical underpinnings and analytical framework for needs-based health workforce planning are well developed and tested, its uptake in national planning processes is still limited. Towards the development of open-access needs-based planning model for national workforce planning, we conducted a systematic scoping review of analytical applications of needs-based health workforce models. Guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses-extension for Scoping Reviews (PRISMA-ScR) checklist, a systematic scoping review was conducted. A systematic search of peer-reviewed literature published in English was undertaken across several databases. Papers retrieved were assessed against predefined inclusion criteria, critically appraised, extracted and synthesized. Twenty-five papers were included, which showed increasing uptake of the needs-based health workforce modelling, with 84% of the studies published within the last decade (2010-20). Three countries (Canada, Australia and England) accounted for 48% of the publications included whilst four studies (16%) were based on low-and-middle-income countries. Only three of the studies were conducted in sub-Saharan Africa. Most of the studies (36%) reported analytical applications for specific disease areas/programs at sub-national levels; 20% focused on the health system need for particular categories of health workers, and only two (8%) reported the analytical application of the needs-based health workforce approach at the level of a national health system across several disease areas/programs. Amongst the studies that conducted long-term projections, the time horizon of the projection was an average of 17 years, ranging from 3 to 33 years. Most of these studies had a minimum time horizon of 10 years. Across the studies, we synthesized six typical methodological considerations for advancing needs-based health workforce modelling. As countries aspire to align health workforce investments with population health needs, the need for some level of methodological harmonization, open-access needs-based models and guidelines for policy-oriented country-level use is not only imperative but urgent.

Advancing the Population Needs-Based Health Workforce Planning Methodology: A Simulation Tool for Country Application

Although the conceptual underpinnings of needs-based health workforce planning have developed over the last two decades, lingering gaps in empirical models and lack of open access tools have partly constrained its uptake in health workforce planning processes in countries. This paper presents an advanced empirical framework for the need-based approach to health workforce planning with an open-access simulation tool in Microsoft^® Excel to facilitate real-life health workforce planning in countries. Two fundamental mathematical models are used to quantify the supply of, and need for, health professionals, respectively. The supply-side model is based on a stock-and-flow process, and the need-side model extents a previously published analytical frameworks using the population health needs-based approach. We integrate the supply and need analyses by comparing them to establish the gaps in both absolute and relative terms, and then explore their cost implications for health workforce policy and strategy. To illustrate its use, the model was used to simulate a real-life example using midwives and obstetricians/gynaecologists in the context of maternal and new-born care in Ghana. Sensitivity analysis showed that if a constant level of health was assumed (as in previous works), the need for health professionals could have been underestimated in the long-term. Towards universal health coverage, the findings reveal a need to adopt the need-based approach for HWF planning and to adjust HWF supply in line with population health needs.

Retirement Decision-Making among Registered Nurses and Allied Health Professionals: A Descriptive Analysis of Canadian Longitudinal Study on Aging Data

A population's health is dependent on the availability of skilled health professionals. We know little about retirement decision-making among publicly employed Canadian registered nurses (RNs) and allied health professionals (AHPs). We identified and compared factors reported to influence early versus 65+ retirement decisions among RNs (n = 794) and AHPs (n = 393). RNs, on average, retired at 58.1 years and AHPs at 59.4 years. More than two thirds retired before age 65. Among RNs, caregiving demands predict early retirement – policies supporting employed RN caregivers may reduce early workforce exits among publicly employed RNs.

Towards defining the surgical workforce for children: a geospatial analysis in Brazil

OBJECTIVES

The optimal size of the health workforce for children's surgical care around the world remains poorly defined. The goal of this study was to characterise the surgical workforce for children across Brazil, and to identify associations between the surgical workforce and measures of childhood health.

DESIGN

This study is an ecological, cross-sectional analysis using data from the Brazil public health system (Sistema Único de Saúde).

SETTINGS AND PARTICIPANTS

We collected data on the surgical workforce (paediatric surgeons, general surgeons, anaesthesiologists and nursing staff), perioperative mortality rate (POMR) and under-5 mortality rate (U5MR) across Brazil for 2015.

PRIMARY AND SECONDARY OUTCOME MEASURES

We performed descriptive analyses, and identified associations between the workforce and U5MR using geospatial analysis (Getis-Ord-Gi analysis, spatial cluster analysis and linear regression models).

FINDINGS

There were 39 926 general surgeons, 856 paediatric surgeons, 13 243 anaesthesiologists and 103 793 nurses across Brazil in 2015. The U5MR ranged from 11 to 26 deaths/1000 live births and the POMR ranged from 0.11-0.17 deaths/100 000 children across the country. The surgical workforce is inequitably distributed across the country, with the wealthier South and Southeast regions having a higher workforce density as well as lower U5MR than the poorer North and Northeast regions. Using linear regression, we found an inverse relationship between the surgical workforce density and U5MR. An U5MR of 15 deaths/1000 births across Brazil is associated with a workforce level of 5 paediatric surgeons, 200 surgeons, 100 anaesthesiologists or 700 nurses/100 000 children.

CONCLUSIONS

We found wide disparities in the surgical workforce and childhood mortality across Brazil, with both directly related to socioeconomic status. Areas of increased surgical workforce are associated with lower U5MR. Strategic investment in the surgical workforce may be required to attain optimal health outcomes for children in Brazil, particularly in rural regions.

Opportunities for, and implications of, skill mix changes in health care pathways: Pay, productivity and practice variations in a needs-based planning framework

Health workforce planning is traditionally based on demographically-driven 'silo-based' models in which future requirements for particular health professions are determined by applying estimates of the future population to the existing population-based level of workforce supply. Estimates of future workforce requirements are focused on, and constrained by population size and requirements increase monotonically. Key failures of existing models include (1) lack of integration between planning the health care workforce, health care services and health care funding and (2) lack of integration between planning different health care inputs and the potential for substitution between inputs. Hence planning models fail to incorporate emerging developments in healthcare delivery and workforce change. We present an integrated needs-based framework for health workforce planning and apply the framework using data from nine European countries to explore the workforce and financial implications of re-configuring the delivery of care through changes in the allocation of treatment tasks between health care professions (skill mix). We show that cost consequences depend not only on pay differences. Instead, workforce planning in rapidly changing workforce environments must consider and incorporate between-provider group differences in productivity (the number of patients that are served per fixed period of time) and practice style (the number and mix of tasks used in providing care to the same type of patient).

Medical school expansion policies: educational access and physician distribution

INTRODUCTION

Many countries are employing strategies intended to reduce maldistribution of health workers and inequities. The purpose of this study was to analyse the impact of expansion policies of medical schools on regional inequalities in the distribution of undergraduate class sizes, and the capacity to attract and retain doctors and to expand health facilities.

METHODS

We conducted a descriptive analysis to compare the distribution of undergraduate places in 2007 and 2016 to determine the impact of targeted expansion policies on inequalities in access to medical education in Brazil. A group of municipalities with new medical schools (n = 54) and a control group without medical schools (n = 408) were compared to analyse impacts of expansion in the health sector. We compared the increase in the number of physicians per 1000 inhabitants and health establishments per inhabitants between 2007 and 2016 based on these two groups. We also analysed the relationship between geographic distance from the state capital and capacity to attract physicians.

RESULTS

There was a decrease in the regional inequalities of undergraduate places in medical schools; the greatest increase in the places per 1000 inhabitants was in municipalities of between 50 000 and 100 000 inhabitants. Municipalities with new medical schools showed an increase in physicians per 1000 inhabitants and in health establishments per inhabitant ratio, demonstrating the potential to attract and retain doctors, as well as strengthening the health infrastructure. Municipalities more distant from state capitals showed a greater increase in physician : inhabitant ratio.

DISCUSSION

Countries with health workforce shortages and inequalities in their distribution might consider public financing and regulation policies for expansion of medical schools as a strategy to attract and retain professionals. Early results in Brazil showed that such strategies could strengthen service networks in deprived areas, supporting implementation of Universal Healthcare Coverage.

Implementing interventions to reduce work-related stress among health-care workers: an investment appraisal from the employer's perspective

Purpose

The Stress-Prevention@Work implementation strategy has been demonstrated to be successful in reducing stress in employees. Now, we assess the economic return-on-investment to see if it would make for a favourable business case for employers.

Methods

Data were collected from 303 health-care workers assigned to either a waitlisted control condition (142 employees in 15 teams) or to Stress-Prevention@Work (161 employees in 15 teams). Main outcome was productivity losses measured using the Trimbos and iMTA Cost questionnaire in Psychiatry. Measurements were taken at baseline, 6, and 12 months post-baseline.

Results

The per-employee costs of the strategy were €50. Net monetary benefits were the benefits (i.e., improved productivity) minus the costs (i.e., intervention costs) and were the main outcome of this investment appraisal. Per-employee net benefits amounted to €2981 on average, which was an almost 60-fold payout of the initial investment of €50. There was a 96.7% likelihood for the modest investment of €50 to be offset by cost savings within 1 year. Moreover, a net benefit of at least €1000 still has a likelihood of 88.2%.

Conclusions

In general, there was a high likelihood that Stress-Prevention@Work offers an appealing business case from the perspective of employers, but the employer should factor in the additional per-employee costs of the stress-reducing interventions. Still, if these additional costs were as high as €2981, then costs and benefits would break even.

This study was registered in the Netherlands National Trial Register, trial code: NTR5527.

The evolution of New Zealand's health workforce policy and planning system: a study of workforce governance and health reform

INTRODUCTION

While considerable attention has been given to improving health workforce planning practice, few articles focus on the relationship between health workforce governance and health reform. By outlining a sequence of health reforms, we reveal how New Zealand's health workforce governance and practices came under pressure, leading to a rethink and the introduction of innovative approaches and initiatives.

CASE DESCRIPTION

New Zealand's health system was quite stable up to the late 1980s, after which 30 years of structural and system reform was undertaken. This had the effect of replacing the centralised medically led health workforce policy and planning system with a market-driven and short-run employer-led planning approach. The increasing pressures and inconsistencies this approach produced ultimately led to the re-centralisation of some governance functions and brought with it a new vision of how to better prepare for future health needs. While significant gain has been made implementing this new vision, issues remain for achieving more effective innovation diffusion and improved integrated care orientations.

DISCUSSION AND EVALUATION

The case reveals that there was a failure to consider the health workforce in almost all of the reforms. Health and workforce policy became increasingly disconnected at the central and regional levels, leading to fragmentation, duplication and widening gaps. New Zealand's more recent workforce policy and planning approach has adopted new tools and techniques to overcome these weaknesses that have implications for the workforce and service delivery, workforce governance and planning methodologies. However, further strengthening of workforce governance is required to embed the changes in policy and planning and to improve organisational capabilities to diffuse innovation and respond to evolving roles and team-based models of care.

CONCLUSION

The case reveals that disconnecting the workforce from reform policy leads to a range of debilitating effects. By addressing how it approaches workforce planning and policy, New Zealand is now better placed to plan for a future of integrated and team-based health care. The case provides cues for other countries considering reform agendas, the most important being to include and consider the health workforce in health reform processes.

A dynamic, multi-professional, needs-based simulation model to inform human resources for health planning

BACKGROUND

As population health needs become more complex, addressing those needs increasingly requires the knowledge, skills, and judgment of multiple types of human resources for health (HRH) working interdependently. A growing emphasis on team-delivered health care is evident in several jurisdictions, including those in Canada. However, the most commonly used HRH planning models across Canada and other countries lack the capacity to plan for more than one type of HRH in an integrated manner. The purpose of this paper is to present a dynamic, multi-professional, needs-based simulation model to inform HRH planning and demonstrate the importance of two of its parameters-division of work and clinical focus-which have received comparatively little attention in HRH research to date.

METHODS

The model estimates HRH requirements by combining features of two previously published needs-based approaches to HRH planning-a dynamic approach designed to plan for a single type of HRH at a time and a multi-professional approach designed to compare HRH supply with requirements at a single point in time. The supplies of different types of HRH are estimated using a stock-and-flow approach.

RESULTS

The model makes explicit two planning parameters-the division of work across different types of HRH, and the degree of clinical focus among individual types of HRH-which have previously received little attention in the HRH literature. Examples of the impacts of these parameters on HRH planning scenarios are provided to illustrate how failure to account for them may over- or under-estimate the size of any gaps between the supply of and requirements for HRH.

CONCLUSION

This paper presents a dynamic, multi-professional, needs-based simulation model which can be used to inform HRH planning in different contexts. To facilitate its application by readers, this includes the definition of each parameter and specification of the mathematical relationships between them.

Fortitude and resilience in service of the population: a case study of dental professionals striving for health in Sierra Leone

OBJECTIVE

Sierra Leone (SL), with a population of over 7 million people, has a critical health workforce shortage. This research explores the views of key players on population oral health needs and demands, the challenges of oral and dental care delivery, and professional careers in dentistry, in order to inform future capacity building.

MATERIALS AND METHODS

Semi-structured interviews were conducted with a purposive sample of key players in dentistry and healthcare, both in-country and externally. An interpretive phenomenological approach was used in exploring views of key-players on the oral needs and demands of population, challenges in the delivery of oral and dental care, professional careers of dental professionals in SL, and future workforce capacity building based on a topic guide drawn from the available literature. Interviews were audio-recorded, transcribed verbatim, anonymised and analysed using QSR NVivo 10 for data management and reported in accordance to the consolidated criteria for reporting qualitative research.

RESULTS

Twenty-one informants, of whom 18 were male, 17 were in-country and 16 were dental professionals, participated in the research. Dental professionals reported clear consensus on a considerable level of unmet oral health needs, most notably dental caries and periodontal disease, together with life threatening oral conditions such as osteomyelitis, Ludwig's Angina and Burkitt's Lymphoma. Challenges associated with the delivery of dental care revolved around five themes: patients' predisposition for traditional remedies and urgent care; practical hindrances to the delivery of care; professional isolation and weak governance; and place with pressing local crises and lack of political will. An emerging typology of dental professionals included: demonstrating loyalty to their nation and family; exhibiting resilience in challenging circumstances; embracing opportunity most notably amongst expatriates; and striving to serve the needs of the population. There was support for innovative future capacity building developments.

CONCLUSION

This paper provides important insights to the delivery of dental care in a low-income country with significant oral health needs and multiple challenges in the delivery of dental care, whilst also providing a vision for developing, building and retaining future human resources for oral health.

Learning Together: Integration of Advanced Practice Providers into a General Medicine Ward Team

BACKGROUND

The Accreditation Council for Graduate Medical Education (ACGME) demands that physicians should be trained to engage in clinical activities with other health profession providers. Incorporation of advanced practice providers (APPs) into medicine ward teams has not yet been described.

AIM

To describe a pilot and feasibility evaluation of an interprofessional general medicine ward team with internal medicine residents and APPs to encourage resident leadership development, enhance service to education balance, and promote interprofessional collaboration.

SETTING

University of Colorado, Internal Medicine Residency Program.

PARTICIPANTS

Sixteen internal medicine residents, 16 interns, 19 Department of Medicine faculty members, and 8 advanced practice provider fellows in hospital medicine.

PROGRAM DESCRIPTION

The authors describe an interprofessional general medicine ward team including team structure, and roles and responsibilities of each team member.

PROGRAM EVALUATION

Each team member completed an electronic survey following the rotation and the majority agreed that the pilot team allowed for an enhanced resident leadership role, and helped to restore the service to education balance and interprofessional collaboration.

DISCUSSION

An interprofessional general medicine ward team is feasible, has the potential to optimize service to education balance, and exposes learners to a collaborative interprofessional clinical environment.

Policies and strategies to retain and support the return of experienced GPs in direct patient care: the ReGROUP mixed-methods study

Background

UK general practice faces a workforce crisis, with general practitioner (GP) shortages, organisational change, substantial pressures across the whole health-care system and an ageing population with increasingly complex health needs. GPs require lengthy training, so retaining the existing workforce is urgent and important.

Objectives

(1) To identify the key policies and strategies that might (i) facilitate the retention of experienced GPs in direct patient care or (ii) support the return of GPs following a career break. (2) To consider the feasibility of potentially implementing those policies and strategies.

Design

This was a comprehensive, mixed-methods study.

Setting

This study took place in primary care in England.

Participants

General practitioners registered in south-west England were surveyed. Interviews were with purposively selected GPs and primary care stakeholders. A RAND/UCLA Appropriateness Method (RAM) panel comprised GP partners and GPs working in national stakeholder organisations. Stakeholder consultations included representatives from regional and national groups.

Main outcome measures

Systematic review – factors affecting GPs’ decisions to quit and to take career breaks. Survey – proportion of GPs likely to quit, to take career breaks or to reduce hours spent in patient care within 5 years of being surveyed. Interviews – themes relating to GPs’ decision-making. RAM – a set of policies and strategies to support retention, assessed as ‘appropriate’ and ‘feasible’. Predictive risk modelling – predictive model to identify practices in south-west England at risk of workforce undersupply within 5 years. Stakeholder consultation – comments and key actions regarding implementing emergent policies and strategies from the research.

Results

Past research identified four job-related ‘push’ factors associated with leaving general practice: (1) workload, (2) job dissatisfaction, (3) work-related stress and (4) work–life balance. The survey, returned by 2248 out of 3370 GPs (67%) in the south-west of England, identified a high likelihood of quitting (37%), taking a career break (36%) or reducing hours (57%) within 5 years. Interviews highlighted three drivers of leaving general practice: (1) professional identity and value of the GP role, (2) fear and risk associated with service delivery and (3) career choices. The RAM panel deemed 24 out of 54 retention policies and strategies to be ‘appropriate’, with most also considered ‘feasible’, including identification of and targeted support for practices ‘at risk’ of workforce undersupply and the provision of formal career options for GPs wishing to undertake portfolio roles. Practices at highest risk of workforce undersupply within 5 years are those that have larger patient list sizes, employ more nurses, serve more deprived and younger populations, or have poor patient experience ratings. Actions for national organisations with an interest in workforce planning were identified. These included collection of data on the current scope of GPs’ portfolio roles, and the need for formal career pathways for key primary care professionals, such as practice managers.

Limitations

The survey, qualitative research and modelling were conducted in one UK region. The research took place within a rapidly changing policy environment, providing a challenge in informing emergent policy and practice.

Conclusions

This research identifies the basis for current concerns regarding UK GP workforce capacity, drawing on experiences in south-west England. Policies and strategies identified by expert stakeholders after considering these findings are likely to be of relevance in addressing GP retention in the UK. Collaborative, multidisciplinary research partnerships should investigate the effects of rolling out some of the policies and strategies described in this report.

Study registration

This study is registered as PROSPERO CRD42016033876 and UKCRN ID number 20700.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

The implementation process of the Workload Indicators Staffing Need (WISN) method by WHO in determining midwifery staff requirements in Greek Hospitals

INTRODUCTION

One of the greatest challenges in the healthcare field is planning the health workforce under limited financial resources while being fully capable of responding to an affordable, fair and efficient healthcare system. This study aimed to demonstrate the implementation process of the health workforce planning tool 'Workload Indicators of Staffing Needs' introduced by the World Health Organization.

METHODS

A descriptive and cross-sectional study was carried out at four (two public and two private) hospitals in Greece, to estimate midwifery staff requirements at ward level during 2015-2016, using the WISN software tool. Focus group discussions, structured interviews and annual service statistics from the hospitals' records were used to obtain data.

RESULTS

Results for both private hospitals showed a shortage in the number of midwives. However, after combining the interpretation of the results, as indicated by the WISN methodology and the structured interviews, current and required staffing is in balance in both. On the other hand, both public hospitals indicate a surplus of midwives (1.83 and 1.33 ratios for the General hospitals in Korinthos and Kalamata, respectively).

CONCLUSIONS

This study demonstrated the implementation process of the WISN methodology through its application in midwifery staff at four hospitals in Greece and confirmed its usefulness in estimating staffing requirements. The application of the WISN methodology should be viewed as a vital tool in assessing overstaffing and understaffing through the estimation of workload pressure among different categories of health staff, thus providing the basis for effective health workforce redistribution in Greece.

Demonstrating a new approach to planning and monitoring rural medical training distribution to meet population need in North West Queensland

BACKGROUND

Improving the health of rural populations requires developing a medical workforce with the right skills and a willingness to work in rural areas. A novel strategy for achieving this aim is to align medical training distribution with community need. This research describes an approach for planning and monitoring the distribution of general practice (GP) training posts to meet health needs across a dispersed geographic catchment.

METHODS

An assessment of the location of GP registrars in a large catchment of rural North West Queensland (across 11 sub-regions) in 2017 was made using national workforce supply, rurality and other indicators. These included (1): Index of Access -spatial accessibility (2); 10-year District of Workforce Shortage (DWS) (3); MMM (Modified Monash Model) rurality (4); SEIFA (Socio-Economic Indicator For Areas) (5); Indigenous population and (6) Population size. Distribution was determined relative to GP workforce supply measures and population health needs in each health sub-region of the catchment. An expert panel verified the approach and reliability of findings and discussed the results to inform planning.

RESULTS

378 registrars and 582 supervisors were well-distributed in two sub-regions; in contrast the distribution was below expected levels in three others. Almost a quarter of registrars (24%) were located in the poorest access areas (Index of Access) compared with 15% of the population located in these areas. Relative to the population size, registrars were proportionally over-represented in the most rural towns, those consistently rated as DWS or those with the poorest SEIFA value and highest Indigenous proportion.

CONCLUSIONS

Current regional distribution was good, but individual town-level data further enabled the training provider to discuss the nuance of where and why more registrars (or supervisors) may be needed. The approach described enables distributed workforce planning and monitoring applicable in a range of contexts, with increased sensitivity for registrar distribution planning where most needed, supporting useful discussions about the potential causes and solutions. This evidence-based approach also enables training organisations to engage with local communities, health services and government to address the sustainable development of the long-term GP workforce in these towns.

A labor requirements function for sizing the health workforce

BACKGROUND

Ensuring healthcare delivery is dependent both on the prediction of the future demand for healthcare services and on the estimation and planning for the Health Human Resources needed to properly deliver these services. Although the Health Human Resources planning is a fascinating and widely researched topic, and despite the number of methodologies that have been used, no consensus on the best way of planning the future workforce requirements has been reported in the literature. This paper aims to contribute to the extension and diversity of the range of available methods to forecast the demand for Health Human Resources and assist in tackling the challenge of translating healthcare services to workforce requirements.

METHODS

A method to empirically quantify the relation between healthcare services and Health Human Resources requirements is proposed. For each one of the three groups of specialties identified-Surgical specialties, Medical specialties and Diagnostic specialties (e.g., pathologists)-a Labor Requirements Function relating the number of physicians with a set of specialty-specific workload and capital variables is developed. This approach, which assumes that health managers and decision-makers control the labor levels more easily than they control the amount of healthcare services demanded, is then applied to a panel dataset comprising information on 142 public hospitals, during a 12-year period.

RESULTS

This method provides interesting insights on healthcare services delivery: the number of physicians required to meet expected variations in the demand for healthcare, the effect of the technological progress on healthcare services delivery, the time spent on each type of care, the impact of Human Resources concentration on productivity, and the possible resource allocations given the opportunity cost of the physicians' labor.

CONCLUSIONS

The empirical method proposed is simple and flexible and produces statistically strong models to estimate Health Human Resources requirements. Moreover, it can enable a more informed allocation of the available resources and help to achieve a more efficient delivery of healthcare services.

Indigenous model of care to health and social care workforce planning

Indigenous people have always had the end in mind-a long range vision for the health and wellbeing of their families and communities. Creating Indigenous solutions-oriented approaches to strategic health and social care workforce planning is an essential component to the realization of self-determination and empowerment, accessible health services, community participation, and flexible approaches to care. This article suggests using an Indigenous "models of care" population health approach to health and social care workforce planning that takes a critical thinking, systems thinking, and design thinking approach using digital tools (eg, scenario planning and population health simulation). It also proposes to increase the number of Indigenous professionals through Indigenous partnership initiatives with professional groups and academic institutions. This article is written to encourage discussion on the use of a whole system approach to developing Indigenous models of health delivery and to inform strategic services and workforce planning.

Forecast of Healthcare Facilities and Health Workforce Requirements for the Public Sector in Ghana, 2016-2026

Background: Ghana is implementing activities towards universal health coverage (UHC) as well as the attainment of the health-related Sustainable Development Goals (SDGs) by the health sector by the year 2030. Aside lack of empirical forecast of the required healthcare facilities to achieve these mandates, health workforce deficits are also a major threat. We therefore modelled the needed healthcare facilities in Ghana and translated it into year-by-year staffing requirements based on established staffing standards.

Methods: Two levels of modelling were used. First, a predictive model based on Markov processes was used to estimate the future healthcare facilities needed in Ghana. Second, the projected healthcare facilities were translated into aggregate staffing requirements using staffing standards developed by Ghana’s Ministry of Health (MoH).

Results: The forecast shows a need to expand the number/capacity of healthcare facilities in order to attain UHC. All things being equal, the requisite healthcare infrastructure for UHC would be attainable from 2023. The forecast also shows wide variations in staffing-need-availability rate, ranging from 15% to 94% (average being 68%) across the various staff types. Thus, there are serious shortages of staff which are worse amongst specialists.

Conclusion: Ghana needs to expand and/or increase the number of healthcare facilities to facilitate the attainment of UHC. Also, only about 68% of the health workforce (HWF) requirements are employed and available for service delivery, leaving serious shortages of the essential health professionals. Immediate recruitment of unemployed but qualified health workers is therefore imperative. Also, addressing health worker productivity, equitable distribution of existing workers, and attrition may be the immediate steps to take whilst a long-term commitment to comprehensively address HWF challenges, including recruitments, expansion and streamlining of HWF training, is pursued.

A geographical workforce analysis of hand therapy services in relation to US population characteristics

INTRODUCTION

A paucity of work force planning literature exists for hand therapy services.

PURPOSE

This descriptive study aimed to map the geographical distribution of US Certified Hand Therapists (CHTs) and describe characteristics of US populations living in respective CHT workplace Zip Code Tabulation Areas (ZCTAs).

METHODS

A de-identified Zip Code list of all active CHTs through April 2016 from the Hand Therapy Certification Commission, included 5572 CHTs with US ZCTAs. The CHT ZCTAs were matched with population parameters "rurality", "poverty" and "race and ethnicity" from the 2010 US Census and 2014 American Community Survey.

RESULTS

The 5,572 CHTs practice ZCTAs mostly overlapped with high density US population areas, covering just 9% of the total number of 33,120 US ZCTAs. The population in CHT ZCTAs was 1) urban in nature, 2) with lower poverty rates than ZCTAs without CHTs, and 3) mostly reflecting US race and ethnicity population distribution. Only 3.7% of CHTs worked in large concentrations of 11 to 26 CHTs per ZCTA near or in urban centers. Most CHTs, 67%, worked in one to three CHTs per ZCTA concentrations, contributing to a larger geographic spread of CHT locations than expected.

DISCUSSION AND CONCLUSION

This study provides a foundational snap shot of the distribution, the potential availability, of the 2016 CHT workforce in the context of US population characteristics. It may serve as baseline for supply and demand studies and interventions to grow the CHT profession and optimize the distribution of CHTs to better meet population needs.

Preferred and actual retirement age of oral and maxillofacial surgeons aged 55 and older in the Netherlands: a longitudinal study from 2003 to 2016

BACKGROUND

In workforce planning for oral and maxillofacial surgeons in the Netherlands, it is important to plan timely, as these dental specialists are required to earn both medical and dental degrees. An important factor to take into account in workforce planning is the outflow of the profession through retirement. In the workforce planning in the Netherlands, it was assumed that retirement plans are a predictor for the actual moment of retirement. The purpose of this study was to investigate this assumption.

METHODS

A standardised survey to investigate the work activity and retirement plans of oral and maxillofacial surgeons was conducted seven times between 2003 and 2016. With some minor variations, in every edition, all oral and maxillofacial surgeons aged 55 years and older who did not indicate to be retired in an earlier edition were invited to participate. The data of all seven editions was analysed to investigate what factors influence the actual retirement age. For the analyses of the data, ANOVA and linear regression were employed.

RESULTS

The response rate was at least 80% in all editions. For all editions combined, 185 surgeons were invited one or more times, of whom 170 responded at least once. Between 2003 and 2016, the mean preferred retirement age increased from 63.7 to 66.7. Two thirds of the respondents who participated in more than one edition had revised their preferred retirement age upwards. Regarding the difference between preferred and actual retirement age, 45% of the oral and maxillofacial surgeons retired at a higher age than originally preferred and another 14% was still working at the age the originally preferred to retire. Linear regression shows that preferred retirement age is associated with sex and the number of working hours and that actual retirement age is associated with preferred retirement age, earlier preference to decrease working hours and working in non-academic hospitals.

CONCLUSION

Altogether, it seems that in this group the preferred retirement age has some predictive value, but the oral and maxillofacial surgeons tend to retire at a higher age than they originally preferred to.

Delivery of Global Cancer Care: An International Study of Medical Oncology Workload

Background

To our knowledge, there is no literature that has described medical oncology (MO) workload in the global context. Here, we report results of an international study of global MO workload.

Methods

An online survey was distributed through a snowball method via national oncology societies to chemotherapy-prescribing physicians in 65 countries. Countries were classified into low- or low-middle–income countries (LMICs), upper-middle–income countries (UMICs), and high-income countries (HICs) on the basis of World Bank criteria. Workload was measured as the annual number of new consultations provided to patients with cancer per oncologist.

Results

A total of 1,115 physicians completed the survey: 13% (147 of 1,115) from LMICs, 17% (186 of 1,115) from UMICs, and 70% (782 of 1,115) from HICs. Eighty percent (897 of 1,115) of respondents were medical oncologists, 10% (109 of 1,115) were clinical oncologists, and 10% (109 of 1,115) were other. The median number of annual consults per oncologist was 175 (interquartile range, 75 to 275); 13% (140 of 1,103) saw ≥ 500 new patients in a year. Annual case volume in LMICs (median consults, 425; 40% of respondents seeing > 500 consults) was substantially higher than in UMICs (median consults, 175; 14% > 500) and HICs (median consults, 175; 7% > 500; P < .001). Among LMICs, UMICs, and HICs, median working days per week were 6, 5, and 5, respectively (P < .001). The highest annual case volumes per oncologist were in Pakistan (median consults, 950; 73% > 500 consults), India (median consults, 475; 43% > 500), and Turkey (median consults, 475; 27% > 500).

Conclusion

There is substantial global variation in medical oncology case volumes and clinical workload; this is most striking among LMICs, where huge deficits exist. Additional work is needed, particularly detailed country-level mapping, to quantify activity-based global MO practice and workload to inform training needs and the design of new pathways and models of care.