Health Workforce Canada: A Source of Innovation in Health Workforce Planning.

The Joint Action on Health Workforce Planning and Forecasting: Results of a European programme to improve health workforce policies

The goals of a health workforce system are to develop, deploy and sustain an integrated and collaborative network of health workers that is equipped with the necessary skills, supports, incentives, and resources to provide quality care that meets all population health needs in an acceptable, equitable and cost-effective manner. This requires robust data and evidence. A key problem in Canada is that it lags behind comparable OECD countries in terms of health workforce data and digital analytics. As a result, health workforce planning here is ad hoc, sporadic, and siloed by profession or jurisdiction, generating significant costs and inefficiencies for all involved. Health workers in Canada account for more than 10% of all employed Canadians and over 2/3 of all health care spending which amounted to $175 billion in 2019, or nearly 8% of Canada’s total GDP.[i]Recognizing these facts, supporting strategic health workforce planning, policy and management ought to be key priorities for federal and provincial/territorial governments and other health care organizations. Across all the different stakeholders that make up the complex adaptive health workforce system in Canada, we lack a centralized and coordinated health workforce data, analytics, and strategic planning infrastructure, a neglect that has been readily acknowledged for over a decade. The significant gaps in our knowledge about the health workforce have been exposed during the COVID-19 pandemic causing critical risks for planners to manage during a health crisis. The time is ripe for the federal government to take on a coordinating leadership role to enhance the data infrastructure that provinces, territories, regions, and training programs need to better plan for and support the health workforce. Efforts should centre on three key elements that will improve data infrastructure, bolster knowledge creation, and inform decision-making activities: A new data standard and enhanced health workforce data collection across all stakeholders More timely, accessible, interactive, and fit-for-purpose decision support tools Capacity building in health workforce data analytics, digital tool design, policy analysis and management science. This vision requires an enhanced federal government role to contribute resources to coordinate the collection of accurate, standardized, and more complete health workforce data to support analysis across occupations, sectors, and jurisdictions, with links to relevant patient information, healthcare utilization and outcome data, for more strategic fit-for-purpose planning at the provincial, territorial, regional, and training program levels. In this paper, a proposed vision for enhanced federal support to data-driven and evidence informed health workforce planning, policy and management is presented. First, two data infrastructure and capacity building recommendations include: the federal government should create through a specially earmarked contribution agreement with the Canadian Institute for Health Information a Canadian Health Workforce Initiative dedicated to the necessary enhancement of standardized health workforce data purpose built for strategic planning purposes and associated decision-making tools for targeted planning. In addition to the need to build better data, digital tools, and decision-support infrastructure, there is a parallel need to build the human resources capacity for health workforce analytics. Through a special CIHR-administered fund to build health workforce research capacity, this could include a Strategic Training Investment in Health Workforce Research and a complementary Signature initiative to fund integrated research projects that cut across the existing Scientific Institutes. Building on these two necessary but insufficient building blocks, three options for a coordinating pan Canadian health workforce organization could include one of the following: The federal government could create a dedicated Health Workforce Agency of Canada with an explicit mandate to enhance existing health workforce data infrastructure and decision-support tools for strategic planning, policy, and management across Canada. The federal government could support through a contribution agreement the creation of an arm’s length, not-for-profit organization, Canadian Partnership for Health Workforce, as a steward of a renewed health workforce strategy and to provide health labour market information, training, and management of human resources in the health sector, including support for recruitment and retention. The federal government could support the creation of a more robust, transparent, and accessible secretariate for a Council on Health Workforce, Canada to improve data and decision-making infrastructures, bolster knowledge creation through dedicated funding and policy to inform decision-making and collaborate on topics of mutual interest. Because of the importance of the health workforce to Canada’s economy and pandemic recovery, a sizeable and sustained investment over the course of at least 10 years is needed to build the necessary infrastructure for better decision-making. In addition to building a more robust health system for Canada’s post pandemic recovery, these actions would align with the World Health Organization’s Global Strategy on Human Resources for Health (2016) which encourages all countries (including Canada) by 2030 to have institutional mechanisms in place to effectively steer and coordinate an inter-sectoral health workforce agenda and established mechanisms for HRH data sharing through national health workforce accounts. [i] In 2019, healthcare constituted 11.5% of GDP. Although the data are not readily available for the full costs of the health workforce, it is generally accepted that approximately 70% of health care costs are the costs of labour; 70% of 11.5 is 8.05.

BackgroundThe HEROES (HEalth woRkfOrcE to meet health challengeS) Joint Action aims to advance health workforce planning across the EU, addressing the pressing need for a resilient, sustainable, and accessible health service systems. Given the evident strain on health systems demonstrated during the COVID-19 pandemic, this initiative seeks to address the critical need for strategic HWF planning. Building on previous projects, HEROES will foster the capacity of EU states in workforce planning, preparing the health systems to meet future challenges.MethodsThe study adopts a collaborative framework involving 19 EU countries, segmented into clusters based on health system characteristics. A stepwise approach (‘AS IS,’ ‘TO BE,’ ‘TO DO’) characterizes the methodology, incorporating extensive data collection, stakeholder engagement, and scenario forecasting. Country-level information on HWF Data and Planning will be compared both across countries in clusters and across clusters.ResultsInitial findings indicate significant disparities in health workforce data quality, availability, and planning methodologies among the states. Identified methodologies also involve real-world data applications and predictive analytics to refine health workforce planning. Efforts are underway to define an Advanced Minimum Dataset (AMDS) to synchronize health workforce data and define planning tools across the clusters, as country-level AS IS reports have been finalized and cross-country comparisons are ongoing.ConclusionsCollaborative, data-driven health workforce planning can significantly enhance health system resilience and responsiveness. Recommended public health actions include enhancing HWF data integration, forecasting capabilities, and stakeholder participation, with the aim of shaping national health policies and practices. The public health impact is profound, as it allows to improve health service delivery and workforce adaptability in response to dynamic health demands.Key messages• The HEROES Joint Action advances EU health workforce planning, with the aim of enhancing the resilience and responsiveness of health systems.• Strategic data-driven approaches in health workforce planning are pivotal for resilient, accessible and sustainable healthcare systems.

The 2020–2022 period of the global COVID-19 pandemic exposed the fact that many countries health systems had inadequate health workforce availability. This is despite sustainable health workforces being critical to health service and healthcare delivery, an acknowledgement that drove the significant investment and focus on health workforce development over the previous two decades. As such, this review article discusses health workforce governance and planning, notes its weaknesses, and identifies some of the barriers to the implementation of health workforce policy making and planning and the achievement of sustainable health workforces. Important is the recognition that health workforce planning is long-term in nature, while health workforce decision-making processes are dominated by political processes that have much shorter time frames. The article concludes by offering the approach of backcasting to overcome this dichotomy.

Creating a stable and sustainable health workforce in regional, rural and remote Australia has long been a challenge to health workforce planners, policy makers and researchers alike. Traditional health workforce planning is often reactive and assumes continuation of current patterns of healthcare utilisation. This demonstration project in Far North Queensland exemplifies how participatory regional health workforce planning processes can accurately model current and projected local workforce requirements. The recent establishment of Primary Health Networks (PHNs) with the intent to commission health services tailored to individual healthcare needs underlines the relevance of such an approach. This study used action research methodology informed by World Health Organization (WHO) systems thinking. Four cyclical stages of health workforce planning were followed: needs assessment; health service model redesign; skills-set assessment and workforce redesign; and development of a workforce and training plan. This study demonstrated that needs-based loco-regional health workforce planning can be achieved successfully through participatory processes with stakeholders. Stronger health systems and workforce training solutions were delivered by facilitating linkages and planning processes based on community need involving healthcare professionals across all disciplines and sectors. By focusing upon extending competencies and skills sets, local health professionals form a stable and sustainable local workforce. Concrete examples of initiatives generated from this process include developing a chronic disease inter-professional teaching clinic in a rural town and renal dialysis being delivered locally to an Aboriginal community. The growing trend of policy makers decentralising health funding, planning and accountability and rising health system costs increase the future utility of this approach. This type of planning can also assist the new PHNs to commission health services that meet the needs of the population and contribute to service and system improvement and innovation.

Background and Objectives: Canada is experiencing a health workforce crisis. Integrated models of care, including Ontario Health Team (OHTs), are important examples of large-scale reform focusing on local populations and a regional health workforce. To ensure a workforce meets population needs, we must use a regional approach to workforce planning. While significant work has been published on health workforce planning, few examples of how regional integrated care systems can apply workforce planning models to address population needs exist. This project aims to inform policy to support regional workforce planning for integrated care strategies. Methods: Using an exploratory mixed methods single case study design, an OHT including rural and urban populations served as the case. The selected Health Workforce Planning Model (HWPM) identified in a scoping review was applied. A mixed methods approach included multiple regional, provincial and federal data sources to describe the population, health needs and service providers. Document analysis of publicly available workforce planning documents across all OHTs was completed. Discrete analysis was conducted for quantitative data. Results: Using the HWPM, data was captured regarding service requirements (population data demographics, health status, health services utilization) and capacity (health workforce) to identify potential gaps. 6 federal/provincial data sets were used to describe the population. 19/93 regional organizations completed surveys to obtain workforce data. Review of 54 OHT websites found only 12 had documents mentioning health workforce planning, including strategic plans (66.7%) and other reports. Conclusions: Key recommendations focused on the need for: health workforce planning governance structures and accountability provincially and within OHTs; standardized and comprehensive data and reporting across sectors; and infrastructure at the provincial level and within regions to support health workforce planning.

BackgroundA strong health workforce is a key building block of a well-functioning health system. To achieve health systems goals, policymakers need information on what works to improve and sustain health workforce performance. Most frameworks on health workforce planning and policymaking are high-level and conceptual, and do not provide a structure for synthesizing the growing body of empirical literature on the effectiveness of strategies to strengthen human resources for health (HRH). Our aim is to create a detailed, interactive logic model to map HRH evidence and inform policy development and decision-making.MethodsWe reviewed existing conceptual frameworks and models on health workforce planning and policymaking. We included frameworks that were: (1) visual, (2) comprehensive (not concentrated on specific outcomes or strategies), and (3) designed to support decision-making. We compared and synthesized the frameworks to develop a detailed logic model and interactive evidence visualization tool.ResultsTen frameworks met our inclusion criteria. The resulting logic model, available at hrhvisualizer.org, allows for visualization of high-level linkages as well as a detailed understanding of the factors that affect health workforce outcomes. HRH data and governance systems interact with the context to affect how human resource policies are formulated and implemented. These policies affect HRH processes and strategies that influence health workforce outcomes and contribute to the overarching health systems goals of clinical quality, responsiveness, efficiency, and coverage. Unlike existing conceptual frameworks, this logic model has been operationalized in a highly visual, interactive platform that can be used to map the research informing policies and illuminating their underlying mechanisms.ConclusionsThe interactive logic model presented in this paper will allow for comprehensive mapping of literature around effective strategies to strengthen HRH. It can aid researchers in communicating with policymakers about the evidence behind policy questions, thus supporting the translation of evidence to policy.

Human health resources (HHR) are the keystone of any health system, by delivering health services to the population. According to the WHO, a shortage of the health workforce (physicians and nurses) in the future is expected. On the one hand, ageing populations will need more and different healthcare; on the other hand, the physician’s age average in Europe is increasing. The perspective of the sudden retirement of large groups of professionals in a short time is a main problem to address. Moreover, the training of a physician is a long process, which makes it impossible to cover the needs of those health professionals at short notice. Furthermore, there are health workforce imbalances that should be addressed. On the one hand, the nurse to physician ratio varies significantly across European countries, from below one nurse to every physician in Greece to between four and five per physician in Denmark and Finland (OECD, 2017). The Portuguese ratio, 1.5, is below the European Region average (2.2) and the OECD average (2.8) (OECD, 2017). On the other hand, the proportion of general practitioners among all physicians should be increased, in order to strengthen primary health care (this ratio varies from 0.5 in France to 0.13 in Portugal; 0.2 is the European Region average). The complexity of this topic is highlighted by the WHO, with the process of planning, regulating and managing the HHR being recognized as the heart of the Health 2020 policy. The planning process aims to streamline decision-making to ensure that the right number of HHR is available in the right time and in the right places to meet the population’s needs and to guarantee their equitable access to healthcare as well as high quality services. Although this issue has been present on the public health agenda for many years, it remains nowadays a major concern in several countries. This situation may affect not only the productivity and the overall socio-economic development, but the quality of the healthcare services delivered to patients. In the past 40 years, the planning of the health workforce in Portugal was conducted in a reactive way, lacking a foresight vision based on an integrated, comprehensive and rigorous analysis. Understanding imbalances on the HHR is therefore, essential for the improvement of many outcomes, such as equity access to health care services targeted by the United Nations sustainable development goals for 2016-2030 (WHO, 2016). The health workforce planning is even more critical in the context of limited resources and the hard-to-predict changes such as: (i) in the roles and responsibilities of different health providers, (ii) in the structure and organization of the health service delivery, and (iii) in the demand for health services (Ono et al., 2013). These issues are affected by uncertain factors, namely demography, epidemiology, technology, policy and economy (Dussault, 2015). A lot of research has been devoted to the health workforce planning, from various perspectives: supply-based approaches, demand-based approaches, needs-based approaches and benchmarking (Roberfroid et al., 2009). As far as we know, no one has addressed this problem by using an integrated tool in a rational and transparent way. The project HEALTH_2040 - Future Needs of Human Resources for Health in Portugal, funded by Calouste Gulbenkian Foundation, attempts to tackle these limitations. In particular, this study exploited the use of a panel data analysis with country-fixed effects by following a socio-technical approach to forecast the health workforce needs in Portugal, concerning physicians and nurses till 2040. Departing from this knowledge, it was possible to infer about the training needs of these HHR, both in medium and long run. These results can be used as a starting point to test the impact of different governmental policies. Further research is still needed to geographically distribute the HHR in order to overcome regional inequities.

The Continuing Challenge of Maldistribution of Human Resources for Health

ABSTRACTThis article describes the human resources for health (HRH) policy and action plan development in Barbados, Grenada, and St. Vincent and the Grenadines, the supporting role of the PAHO/WHO Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, and sub-regional action for supporting continuing country-level HRH strengthening. A policy development process, comprising document/literature review and stakeholder consultations, was used to conduct a situational analysis, which informed the HRH policy and action plan. The policies and action plans centered on HRH priority areas of leadership and governance, HRH planning capacity, strengthening primary health care, optimization of pre- and post-licensure education/training, retention and recruitment, deployment and utilization, inter-sectoral and external partnerships for sustainability, health information systems, and HRH research. A cross-sectional analysis of the findings found that HRH challenges and priority areas were consistent across the countries, resulting in similar policy priority actions that are aligned with the regional lines of action for strengthening HRH for universal access to health and universal health coverage. The results support the value-add in collaborating on a regional level to build capacity for needs-based HRH planning within member countries. The Caribbean-Community (CARICOM), with facilitation by Pan American Health Organization (PAHO) Caribbean Subregional Programme, has established the Human Resources for Health Action Task Force for the Caribbean. The expertise of the Dalhousie University PAHO/WHO Collaborating Centre, provided through the technical assistance, supported the three countries in this important initiative and provides for further opportunities to support PAHO, the Task Force, and countries as they work to achieve their HRH strengthening objectives.

Chronic disease management is increasingly informed by clinical practice guidelines (CPGs). However, their implementation requires not only knowledge of guideline content by clinicians and practice processes that support implementation, but also a health workforce with the capacity to deliver care consistent with CPGs. This has a health services planning as well as a health workforce dimension. However, it is not known whether CPGs are described in a way that can inform health services and health workforce planning and potentially drive better quality care. This study aimed to ascertain whether CPGs are useful for health service and health workforce planning. This question was explored taking diabetes mellitus as a case study. A systematic search of Medline, EMBASE, CINAHL and Scopus was carried out to identify all CPGs relating to the management of diabetes mellitus in the primary healthcare setting. The search was limited to guidelines published in the English language between 2003 and 2009. The quality of guidelines was assessed against a subset of criteria set by the Appraisal of Guidelines for Research and Evaluation (AGREE) collaboration. Seventy-five diabetes-related CPGs were identified, of which 27 met the inclusion criteria. In terms of quality, many guidelines adopted evidence-based recommendations for diabetes care (59%) and most were endorsed by national authorities (70%). With regards to coverage of 17 identified subpopulations, guidelines were generally selective in the populations they covered. Whilst many provided adequate coverage of common complications and comorbidities, approaches to management for those with reduced capacity for effective diabetes self-care were largely absent, except for indigenous populations. Clinical practice guidelines are potentially useful for health services and health workforce planning, but would be more valuable for this purpose if they contained more detail about care protocols and specific skills and competencies, especially for subpopulations who would be expected to have reduced capacity for effective self-care. If service planning ignores these subgroups that tend to require more resource-intensive management, underprovision of services is likely.

BackgroundThe World Health Organization adopted the Global Strategy on Human Resources for Health Workforce 2030 in May 2016. It sets specific milestones for improving health workforce planning in member countries, such as developing a health workforce registry by 2020 and ensuring workforce self-sufficiency by halving dependency on foreign-trained health professionals. Canada falls short in achieving these milestones due to the absence of such a registry and a poor understanding of immigrants in the health workforce, particularly nursing and healthcare support occupations. This paper provides a multiscale (Canada, Ontario, and Ontario’s Local Health Integration Networks) overview of immigrant participation in nursing and health care support occupations, discusses associated enumeration challenges, and the implications for health workforce planning focusing on immigrants.MethodsDescriptive data analysis was performed on Canadian Institute for Health Information dataset for 2010 to 2020, and 2016 Canadian Census and other relevant data sources.ResultsThe distribution of nurses in Canada, Ontario, and Ontario’s Local Health Integration Networks reveal a growth in Nurse Practitioners and Registered/Licensed Practical Nurses, and contraction in the share of Registered Nurses. Immigrant entry into the profession was primarily through the practical nurse cadre. Mid-sized communities registered the highest growth in the share of internationally educated nurses. Data also pointed towards the underutilization of immigrants in regulated nursing and health occupations.ConclusionImmigrants comprise an important share of Canada’s nursing and health care support workforce. Immigrant pathways for entering nursing occupations are complex and difficult to accurately enumerate. This paper recommends the creation of an integrated health workforce dataset, including information about immigrant health workers, for both effective national workforce planning and for assessing Canada’s role in global health workforce distribution and utilization.

BackgroundHealth workforce misdistribution leads to severe inequity and low-efficiency in health services in the developing countries. Targeting at China, this research aims to reveal, visualize and compare the geographical distribution patterns of different subtypes of urban and rural health workforce and identify the priority regions for health workforce planning and allocation policies designing.MethodsThe health workforce density (workforce-to-population ratio) is adopted to represent the accessibility to health workforce in each geographical unit. Besides a descriptive geography of health workforce as a whole, the local indicators of spatial association (LISA) are used to explore the spatial clusters of different subtypes of health workforce, which are visualized by geographical tools.ResultsResults reveal that regional disparities and spatial clusters exist in China’s health workforce distribution, with different types of workforce exhibiting relatively different spatial distribution characteristics. Besides, huge urban-rural disparities are found in the distribution of health workforce in China. Unexpectedly but intriguingly, most of the high-high and high-low cluster area of urban health workforce are concentrated in the western China (Xinjiang, Xizang etc.), indicating the relative abundant stock of urban health workforce in these units, while the low-low and low-high cluster area of different types of urban health workforce are mainly distributed in middle China. Regarding the rural health workforce, there is an obvious and similar low-low and low-high clustering pattern in western provinces (Sichuan, Yunnan) for the licensed doctors, pharmacists, technologists, which play a critical role in health services delivery.ConclusionsDifferent types of health workforce displayed distinct spatial distribution patterns, while the misdistribution of rural health workforce imposed more challenges to the Chinese health sector due to its poorer stock and more disadvantaged positions of backward regions (i.e., low-low and low-high cluster area). Subtype-specific and region-oriented health workforce planning and allocation policies are suggested to be made, aiming at the urban and rural health workforce respectively, by prioritizing the identified low-low and low-high cluster areas.

To ensure New Zealand's health workforce was fit for purpose, Health Workforce New Zealand (HWNZ) funded Workforce Service Reviews (WSRs) to develop visions for service reconfiguration and workforce for 2020. This paper describes what makes the WSR processes work, for whom, and in what circumstances. Semi-structured interviews informed by a realist evaluation approach were conducted to obtain perceptions and experiences of WSR participants from four WSRs: eye health, palliative care, anaesthesia and aged care. The WSR process was a successful means of bringing together professionals from across the health disciplines and building sector capacity to develop new ways of thinking about service and workforce planning. WSRs were constrained by: mixed signals about process and outcomes; being challenged not milestone focussed; lacking clarity about ownership of visions; and variable clarity about next steps. WSRs were optimised by having: a lead clinician with policy know-how, ability to inspire, bring people together, distil ideas into coherent frameworks; and a project manager with project enablement skill sets and expertise in complex systems, implementation, change management. Evidence now exists at a point in time about what makes the WSR processes work. Implications for HWNZ are presented using a capacity-building framework to inform future decision making regarding WSRs. WHAT IS KNOWN ABOUT THE TOPIC? More appropriate workforce planning is required to meet the challenges facing the health workforce, from both the demand and the workforce side. To ensure New Zealand's healthcare workforce was fit for purpose, HWNZ initiated an iterative WSR process in topic specific areas. The WSRs process was designed to develop a vision of the relevant health service and workforce for 2020, and models of care that were patient-centred and team-based. WHAT DOES THIS PAPER ADD? The paper provides evidence that the WSR process was a successful means for bringing together professionals from across the health disciplines and building sector capacity to develop new ways of thinking about service and workforce planning. The paper presents key enablers of, and barriers to, the WSR iterative process. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? The evaluation revealed that a multitude of factors can influence the capacity of the WSR process at the individual (workforce skills and abilities), organisational (leadership and interactions) and systems (infrastructure) levels. Implications for HWNZ on ways to build the capacity of the WSRs according to three capacity-building dimensions are presented to inform future decision making.

Health workforce planning is essential for ensuring a resilient and well-functioning healthcare system capable of addressing population needs and responding to crises. In Georgia, an upper-middle-income country, significant challenges remain in the strategic planning, regulation, and management of the health workforce. This policy analysis evaluated health workforce planning approaches in Georgia's dynamic health system context. Health workforce planning in Georgia, guided by the National Health Strategy 2022-2030, prioritises needs-based workforce planning, professional qualifications, and nursing development. However, Georgia faces data inconsistencies, workforce imbalances, and an uneven geographic distribution of healthcare professionals, limiting the efficacy of current policies. The lack of formal health workforce planning, reliance on market-driven approaches, and weak retention strategies contribute to workforce shortages and migration. A centralised planning body, and enhancement in data collection and management, could facilitate the gradual introduction of context-relevant, evidence-based workforce planning methods. By integrating rigorous, long-term workforce planning with intersectoral collaboration and adopting innovative methods like workload-based modelling and hybrid planning methods, Georgia can create a sustainable health workforce aligned with its health system's evolving needs.