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Lee JT, Crettenden I, Tran M, Miller D, Cormack M, Cahill M, Li J, Sugiura T, Xiang F. Methods for health workforce projection model: systematic review and recommended good practice reporting guideline. HUMAN RESOURCES FOR HEALTH 2024; 22:25. [PMID: 38632567 PMCID: PMC11025158 DOI: 10.1186/s12960-024-00895-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/22/2024] [Indexed: 04/19/2024]
Abstract
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.
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Affiliation(s)
- John Tayu Lee
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan.
- National Centre for Health Workforce Studies, College of Health and Medicine, Australian National University, Canberra, Australia.
| | - Ian Crettenden
- National Centre for Health Workforce Studies, College of Health and Medicine, Australian National University, Canberra, Australia
| | - My Tran
- National Centre for Health Workforce Studies, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Daniel Miller
- Health Data Analytics Team, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Mark Cormack
- National Centre for Health Workforce Studies, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Megan Cahill
- National Centre for Health Workforce Studies, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Jinhu Li
- National Centre for Health Workforce Studies, College of Health and Medicine, Australian National University, Canberra, Australia
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Tomoko Sugiura
- Health Data Analytics Team, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Fan Xiang
- National Centre for Health Workforce Studies, College of Health and Medicine, Australian National University, Canberra, Australia
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Geiger I, Schang L, Sundmacher L. Assessing needs-based supply of physicians: a criteria-led methodological review of international studies in high-resource settings. BMC Health Serv Res 2023; 23:564. [PMID: 37259109 DOI: 10.1186/s12913-023-09461-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 04/27/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Many health systems embrace the normative principle that the supply of health services ought to be based on the need for healthcare. However, a theoretically grounded framework to operationalize needs-based supply of healthcare remains elusive. The aim of this paper is to critically assess current methodologies that quantify needs-based supply of physicians and identify potential gaps in approaches for physician planning. To this end, we propose a set of criteria for consideration when estimating needs-based supply. METHODS We conducted searches in three electronic bibliographic databases until March 2020 supplemented by targeted manual searches on national and international websites to identify studies in high-resource settings that quantify needs-based supply of physicians. Studies that exclusively focused on forecasting methods of physician supply, on inpatient care or on healthcare professionals other than physicians were excluded. Additionally, records that were not available in English or German were excluded to avoid translation errors. The results were synthesized using a framework of study characteristics in addition to the proposed criteria for estimating needs-based physician supply. RESULTS 18 quantitative studies estimating population need for physicians were assessed against our criteria. No study met all criteria. Only six studies sought to examine the conceptual dependency between need, utilization and supply. Apart from extrapolations, simulation models were applied most frequently to estimate needs-based supply. 12 studies referred to the translation of need for services with respect to a physician's productivity, while the rest adapted existing population-provider-ratios. Prospective models for estimating future care needs were largely based on demographic predictions rather than estimated trends in morbidity and new forms of care delivery. CONCLUSIONS The methodological review shows distinct heterogeneity in the conceptual frameworks, validity of data basis and modeling approaches of current studies in high-resource settings on needs-based supply of physicians. To support future estimates of needs-based supply, this review provides a workable framework for policymakers in charge of health workforce capacity planning.
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Affiliation(s)
- Isabel Geiger
- Technical University of Munich, Munich, Germany.
- Ludwig-Maximilians-University (LMU) Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Laura Schang
- Pettenkofer School of Public Health, Munich, Germany
| | - Leonie Sundmacher
- Department of Health Economics, Technical University of Munich, Munich, Germany
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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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Cavalleri Ferrari F, Buglioli M, Silvariño R, Boggia J. Proyección de brecha de especialistas en nefrología en Uruguay 2020-2050: aplicación de un modelo de dinámica de sistemas. Rev Salud Publica (Bogota) 2022. [DOI: 10.15446/rsap.v24n4.103065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objetivo Estimar el equilibrio/desequilibrio entre la oferta y la necesidad de nefrólogos en Uruguay para el año 2020 así como la tendencia hacia el 2050.
Métodos Se desarrolló un modelo de simulación, aplicando la metodología de dinámica de sistemas con dos componentes: el de oferta y el de necesidad. Se definió 2020 como el año base y un horizonte de proyección hasta 2050. Se comparó la oferta y la necesidad en el periodo de proyección para establecer la brecha tanto en términos absolutos como relativos.
Resultados La proyección de brecha para todos los escenarios considerados es de superávit en la mayor parte del periodo analizado.
Conclusiones El trabajo aporta insumos respecto de aquellos parámetros sobre los que se puede incidir y que afectan a la oferta de especialistas. El valor de las proyecciones radica en su utilidad para identificar la situación actual y las tendencias futuras a las que deben responder los responsables de la formulación de políticas.
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MacKenzie A, MacQuarrie C, Murphy M, Piers G, Philopoulos K, Carrigan S, Joice J, Kapra J, Casault CA, MacDougall J, Langley JM, Tomblin Murphy G. Operationalizing integrated needs-based workforce planning at Nova Scotia Health in response to the COVID-19 pandemic. Healthc Manage Forum 2022; 35:222-230. [PMID: 35748087 PMCID: PMC9234379 DOI: 10.1177/08404704221093982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
This paper documents Nova Scotia Health’s progress in operationalizing integrated
needs-based workforce planning as part of its ongoing response to the pandemic.
A multidisciplinary workforce planning team with representation spanning key
portfolios was created to facilitate the organization’s response to the
pandemic. Analyses applied early in Wave 3 of the pandemic showed large
projected shortages in several professions and identified which services would
likely be scarcest among the available workforce relative to patient need. Based
on these results, the workforce planning team recommended and supported
operational teams in implementing a multi-faceted set of interventions aimed at
increasing the availability of individuals with these competencies. These
interventions collectively yielded an adequate supply of additional competent
personnel to meet the needs of COVID-19 inpatients across the province through
the third wave of the pandemic. Lessons learned are proving critical to
maintaining core operations during Wave 4 of the pandemic.
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Affiliation(s)
- Adrian MacKenzie
- 432234Nova Scotia Health, Halifax, Nova Scotia, Canada.,Dalhousie University, Halifax, Nova Scotia, Canada.,WHO/PAHO Collaborating Centre on Health Workforce Planning & Research, Halifax, Nova Scotia, Canada
| | | | | | - Geoff Piers
- 432234Nova Scotia Health, Halifax, Nova Scotia, Canada
| | | | | | - Jesse Joice
- 432234Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Junaid Kapra
- 432234Nova Scotia Health, Halifax, Nova Scotia, Canada
| | | | | | - Joanne M Langley
- 432234Nova Scotia Health, Halifax, Nova Scotia, Canada.,Dalhousie University, Halifax, Nova Scotia, Canada.,IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Gail Tomblin Murphy
- 432234Nova Scotia Health, Halifax, Nova Scotia, Canada.,Dalhousie University, Halifax, Nova Scotia, Canada.,WHO/PAHO Collaborating Centre on Health Workforce Planning & Research, Halifax, Nova Scotia, Canada
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Asamani JA, Zurn P, Pitso P, Mothebe M, Moalosi N, Malieane T, Bustamante Izquierdo JP, Zbelo MG, Hlabana AM, Humuza J, Ahmat A, Okoroafor SC, Nabyonga-Orem J, Nyoni J. Health workforce supply, needs and financial feasibility in Lesotho: a labour market analysis. BMJ Glob Health 2022; 7:bmjgh-2021-008420. [PMID: 35609924 PMCID: PMC9131109 DOI: 10.1136/bmjgh-2021-008420] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 04/25/2022] [Indexed: 01/13/2023] Open
Abstract
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.
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Affiliation(s)
- James Avoka Asamani
- Health Workforce Unit, Universal Health Coverage—Life Course, World Health Organization Regional Office for Africa, Brazzaville, Republic of the Congo,Centre for Health Professions Education, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Pascal Zurn
- Health Labour Market Unit, Health Workforce Department, World Health Organization, Geneve, Switzerland
| | - Palesa Pitso
- Human Resources for Health, Open Development Lesotho, Maseru, Lesotho
| | - Mathapelo Mothebe
- Human Resources, Lesotho Ministry of Health and Social Welfare, Maseru, Lesotho
| | | | - Thabo Malieane
- Human Resources, Ministry of Development Planning, Maseru, Lesotho
| | | | | | | | - James Humuza
- Department of Health Policy, Economics and Management, School of Public Health, University of Rwanda, Kigali, Rwanda
| | - Adam Ahmat
- Health Workforce Unit, Universal Health Coverage—Life Course, World Health Organization Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Sunny C Okoroafor
- Health Workforce Unit, Universal Health Coverage—Life Course, World Health Organization Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Juliet Nabyonga-Orem
- Centre for Health Professions Education, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa,Health Financing and Investment Unit, Universal Health Coverage—Life Course, World Health Organization Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Jennifer Nyoni
- Health Workforce Unit, Universal Health Coverage—Life Course, World Health Organization Regional Office for Africa, Brazzaville, Republic of the Congo
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Asamani JA, Christmals CD, Reitsma GM. Modelling the supply and need for health professionals for primary health care in Ghana: Implications for health professions education and employment planning. PLoS One 2021; 16:e0257957. [PMID: 34582504 PMCID: PMC8478216 DOI: 10.1371/journal.pone.0257957] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 09/14/2021] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- James Avoka Asamani
- Centre for Health Professions Education, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
- World Health Organization, Regional Office for Africa, Inter-Country Support Team for Eastern and Southern Africa, Harare, Zimbabwe
| | - Christmal Dela Christmals
- Centre for Health Professions Education, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
- * E-mail:
| | - Gerda Marie Reitsma
- Centre for Health Professions Education, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
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Ghotane SG, Don-Davis P, Kamara D, Harper PR, Challacombe SJ, Gallagher JE. Needs-led human resource planning for Sierra Leone in support of oral health. HUMAN RESOURCES FOR HEALTH 2021; 19:106. [PMID: 34470631 PMCID: PMC8411531 DOI: 10.1186/s12960-021-00623-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 06/17/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND In Sierra Leone (SL), a low-income country in West Africa, dental care is very limited, largely private, and with services focused in the capital Freetown. There is no formal dental education. Ten dentists supported by a similar number of dental care professionals (DCPs) serve a population of over 7.5 million people. The objective of this research was to estimate needs-led requirements for dental care and human resources for oral health to inform capacity building, based on a national survey of oral health in SL. METHODS A dedicated operational research (OR) decision tool was constructed in Microsoft Excel to support this project. First, total treatment needs were estimated from our national epidemiological survey data for three key ages (6, 12 and 15 years), collected using the 'International Caries Classification and Management System (ICCMS)' tool. Second, oral health needs were extrapolated to whole population levels for each year-group, based on census demographic data. Third, full time equivalent (FTE) workforce capacity needs were estimated for mid-level providers in the form of Dental Therapists (DTs) and non-dental personnel based on current oral disease management approaches and clinical timings for treatment procedures. Fourth, informed by an expert panel, three oral disease management scenarios were explored for the national population: (1) Conventional care (CC): comprising oral health promotion (including prevention), restorations and tooth extraction; (2) Surgical and Preventive care (S5&6P and S6P): comprising oral health promotion (inc. prevention) and tooth extraction (D5 and D6 together, & at D6 level only); and (3) Prevention only (P): consisting of oral health promotion (inc. prevention). Fifth, the findings were extrapolated to the whole population based on demography, assuming similar levels of treatment need. RESULTS To meet the needs of a single year-group of childrens' needs, an average of 163 DTs (range: 133-188) would be required to deliver Conventional care (CC); 39 DTs (range: 30-45) to deliver basic Surgical and Preventive care (S6P); 54 DTs for more extended Surgical and Preventive care (S5&6P) (range 38-68); and 27 DTs (range: 25-32) to deliver Prevention only (P). When scaled up to the total population, an estimated 6,147 DTs (range: 5,565-6,870) would be required to deliver Conventional care (CC); 1,413 DTs (range: 1255-1438 DTs) to deliver basic Surgical and Preventive care (S6P); 2,000 DTs (range 1590-2236) for more extended Surgical and Preventive care (S5&6P) (range 1590-2236); and 1,028 DTs to deliver Prevention only (P) (range: 1016-1046). Furthermore, if oral health promotion activities, including individualised prevention, could be delivered by non-dental personnel, then the remaining surgical care could be delivered by 385 DTs (range: 251-488) for the S6P scenario which was deemed as the minimum basic baseline service involving extracting all teeth with extensive caries into dentine. More realistically, 972 DTs (range: 586-1179) would be needed for the S5&6P scenario in which all teeth with distinctive and extensive caries into dentine are extracted. CONCLUSION The study demonstrates the huge dental workforce needs required to deliver even minimal oral health care to the Sierra Leone population. The gap between the current workforce and the oral health needs of the population is stark and requires urgent action. The study also demonstrates the potential for contemporary epidemiological tools to predict dental treatment needs and inform workforce capacity building in a low-income country, exploring a range of solutions involving mid-level providers and non-dental personnel.
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Affiliation(s)
- Swapnil Gajendra Ghotane
- Faculty of Dentistry, Oral & Craniofacial Sciences At King’s College London, Centre for Host Microbiome Interactions, Denmark Hill Campus, Bessemer Road, London, SE5 9RS United Kingdom
| | - Patric Don-Davis
- College of Medicine and Allied Health Sciences, Connaught Hospital, Freetown, Sierra Leone
| | - David Kamara
- Oral Health Department, Connaught Hospital, Freetown, Sierra Leone
| | - Paul R. Harper
- School of Mathematics, Cardiff University, Cardiff, CF24 4AG UK
| | - Stephen J. Challacombe
- Faculty of Dentistry, Oral and Craniofacial Sciences At King’s College London, Centre for Host Microbiome Interactions, Guys Campus, London, SE1 9RT UK
| | - Jennifer E. Gallagher
- Faculty of Dentistry, Oral & Craniofacial Sciences At King’s College London, Centre for Host Microbiome Interactions, Denmark Hill Campus, Bessemer Road, London, SE5 9RS United Kingdom
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Taghavi M, Johnston G, Urquhart R, Henderson D, Tschupruk C, Tupala B. Workforce Planning for Community-Based Palliative Care Specialist Teams Using Operations Research. J Pain Symptom Manage 2021; 61:1012-1022.e4. [PMID: 32942008 PMCID: PMC7490249 DOI: 10.1016/j.jpainsymman.2020.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/22/2020] [Accepted: 09/04/2020] [Indexed: 11/27/2022]
Abstract
CONTEXT Many countries have aging populations. Thus, the need for palliative care will increase. However, the methods to estimate optimal staffing for specialist palliative care teams are rudimentary as yet. OBJECTIVES To develop a population-need workforce planning model for community-based palliative care specialist teams and to apply the model to forecast the staff needed to care for all patients with terminal illness, organ failure, and frailty during the next 20 years, with and without the expansion of primary palliative care. METHODS We used operations research (linear programming) to model the problem. We used the framework of the Canadian Society of Palliative Care Physicians and the Nova Scotia palliative care strategy to apply the model. RESULTS To meet the palliative care needs for persons dying across Nova Scotia in 2019, the model generated an estimate of 70.8 nurses, 23.6 physicians, and 11.9 social workers, a total of 106.3 staff. Thereby, the model indicated that a 64% increase in specialist palliative care staff was needed immediately, and a further 13.1% increase would be needed during the next 20 years. Trained primary palliative care providers currently meet 3.7% of need, and with their expansion are expected to meet 20.3% by 2038. CONCLUSION Historical, current, and projected data can be used with operations research to forecast staffing levels for specialist palliative care teams under various scenarios. The forecast can be updated as new data emerge, applied to other populations, and used to test alternative delivery models.
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Affiliation(s)
- Majid Taghavi
- Saint Mary's University, Halifax, Nova Scotia, Canada.
| | - Grace Johnston
- Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Robin Urquhart
- Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - David Henderson
- Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax, Nova Scotia, Canada
| | | | - Beth Tupala
- Hospice Halifax, Halifax, Nova Scotia, Canada
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Asamani JA, Christmals CD, Reitsma GM. The needs-based health workforce planning method: a systematic scoping review of analytical applications. Health Policy Plan 2021; 36:1325-1343. [PMID: 33657210 DOI: 10.1093/heapol/czab022] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 12/28/2022] Open
Abstract
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.
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Affiliation(s)
- James Avoka Asamani
- Centre for Health Professions Education, Faculty of Health Sciences, North-West University, Potchefstroom Campus, Building PC-G16, Office 101,11 Hoffman St, Potchefstroom, 2520, North West Province, South Africa.,World Health Organisation, Regional Office for Africa. Universal Health Coverage - Life Course Cluster Intercountry Support Team for Eastern and Southern Africa 82 - 86 Cnr Enterprise/Glenara Roads Highlands, Harare, Zimbabwe
| | - Christmal Dela Christmals
- Centre for Health Professions Education, Faculty of Health Sciences, North-West University, Potchefstroom Campus, Building PC-G16, Office 101,11 Hoffman St, Potchefstroom, 2520, North West Province, South Africa
| | - Gerda Marie Reitsma
- Centre for Health Professions Education, Faculty of Health Sciences, North-West University, Potchefstroom Campus, Building PC-G16, Office 101,11 Hoffman St, Potchefstroom, 2520, North West Province, South Africa
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11
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Advancing the Population Needs-Based Health Workforce Planning Methodology: A Simulation Tool for Country Application. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042113. [PMID: 33671553 PMCID: PMC7926568 DOI: 10.3390/ijerph18042113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/11/2021] [Accepted: 02/18/2021] [Indexed: 12/02/2022]
Abstract
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.
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Padigos J, Reid S, Kirby E, Broom J. Knowledge, perceptions and experiences of nurses in antimicrobial optimization or stewardship in the intensive care unit. J Hosp Infect 2020; 109:10-28. [PMID: 33290817 DOI: 10.1016/j.jhin.2020.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 12/13/2022]
Abstract
There is an urgent and recognized need for an interprofessional collaborative approach to support global action in addressing antimicrobial resistance (AMR). Antimicrobial stewardship (AMS) refers to systematic approaches for antimicrobial optimization within healthcare organizations. In areas with high antimicrobial utilization such as intensive care units (ICUs), specific roles for nurses in AMS are not clearly defined. This review aimed to identify and to critically evaluate primary studies that examined knowledge, perspectives and experiences of nurses associated with antimicrobial use and optimization in ICUs. A systematic search of Medline, CINAHL, PsychINFO, EMBASE, PubMed, SCOPUS, Cochrane Library and Web of Science databases for primary studies published from 1st January 2000 to 20th March 2020 was performed. A convergent synthesis design was used to synthesize quantitative and qualitative data. Of the 898 studies initially screened, 26 were included. Most (18/26) studies were quantitative. All qualitative studies (6/26) were of high methodological quality. Studies where interventions were used (10/26) identified significant potential for ICU nurses to reduce antimicrobial use, time-to-antibiotic administration, and error rates. Barriers to nursing engagement included knowledge deficits in antimicrobial use, interprofessional dissonance and the culture of deference to physicians. Enhancing education, technology utilization, strong nursing leadership and robust organizational structures that support nurses were perceived as enablers to strengthen their roles in optimizing antimicrobial use. This review showed that nursing initiatives have significant potential to strengthen antimicrobial optimization in ICUs. Barriers and enablers to active engagement were identified.
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Affiliation(s)
- J Padigos
- Intensive Care Unit, Sunshine Coast University Hospital, Birtinya, Queensland, 4551, Australia; Faculty of Medicine, The University of Queensland, Herston, Queensland, 4006, Australia.
| | - S Reid
- Faculty of Medicine, The University of Queensland, Herston, Queensland, 4006, Australia
| | - E Kirby
- Centre for Social Research in Health, University of New South Wales, Sydney 2052, New South Wales, Australia
| | - J Broom
- Faculty of Medicine, The University of Queensland, Herston, Queensland, 4006, Australia; Department of Infectious Diseases, Sunshine Coast University Hospital, Birtinya, Queensland 4551, Australia
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13
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The factors affecting the obstetricians-gynecologists workforce planning: A systematic review. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2019.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Wise S, Duffield C, Fry M, Roche M. Clarifying workforce flexibility from a division of labor perspective: a mixed methods study of an emergency department team. HUMAN RESOURCES FOR HEALTH 2020; 18:17. [PMID: 32143632 PMCID: PMC7060538 DOI: 10.1186/s12960-020-0460-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 02/24/2020] [Indexed: 05/25/2023]
Abstract
BACKGROUND The need for greater flexibility is often used to justify reforms that redistribute tasks through the workforce. However, "flexibility" is never defined or empirically examined. This study explores the nature of flexibility in a team of emergency doctors, nurse practitioners (NPs), and registered nurses (RNs), with the aim of clarifying the concept of workforce flexibility. Taking a holistic perspective on the team's division of labor, it measures task distribution to establish the extent of multiskilling and role overlap, and explores the behaviors and organizational conditions that drive flexibly. METHODS The explanatory sequential mixed methods study was set in the Fast Track area of a metropolitan emergency department (ED) in Sydney, Australia. In phase 1, an observational time study measured the tasks undertaken by each role (151 h), compared as a proportion of time (Kruskal Wallis, Mann-Whitney U), and frequency (Pearson chi-square). The time study was augmented with qualitative field notes. In phase 2, 19 semi-structured interviews sought to explain the phase 1 observations and were analyzed thematically. RESULTS The roles were occupationally specialized: "Assessment and Diagnosis" tasks consumed the largest proportion of doctors' (51.1%) and NPs' (38.1%) time, and "Organization of Care" tasks for RNs (27.6%). However, all three roles were also multiskilled, which created an overlap in the tasks they performed. The team used this role overlap to work flexibly in response to patients' needs and adapt to changing demands. Flexibility was driven by the urgent and unpredictable workload in the ED and enabled by the stability provided by a core group of experienced doctors and nurses. CONCLUSION Not every healthcare team requires the type of flexibility found in this study since that was shaped by patient needs and the specific organizational conditions of the ED. The roles, tasks, and teamwork that a team requires to "be flexible" (i.e., responsive and adaptable) are highly context dependent. Workforce flexibility therefore cannot be defined as a particular type of reform or role; rather, it should be understood as the capacity of a team to respond and adapt to patients' needs within its organizational context. The study's findings suggest that solutions for a more flexible workforce may lay in the organization of healthcare work.
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Affiliation(s)
- Sarah Wise
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, PO Box 123, Broadway, NSW, 2007, Australia.
| | - Christine Duffield
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW, 2007, Australia
- School of Nursing and Midwifery, Edith Cowan University, Australia, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
| | - Margaret Fry
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW, 2007, Australia
- Director Research and Practice Development Nursing and Midwifery Directorate, Northern Sydney Local Health District, Royal North Shore Hospital, Kolling Building, St Leonards, NSW, 2065, Australia
| | - Michael Roche
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW, 2007, Australia
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