Why HR Has Failed to Address Healthcare's Workforce Crisis: The Need for a Systems Partner Role

BackgroundIncreasing the availability of health workers in remote and rural areas through improved health workforce recruitment and retention is crucial to population health. However, information about the costs of such policy interventions often appears incomplete, fragmented or missing, despite its importance for the sound selection, planning, implementation and evaluation of these policies. This lack of a systematic approach to costing poses a serious challenge for strong health policy decisions.MethodsThis paper proposes a framework for carrying out a costing analysis of interventions to increase the availability of health workers in rural and remote areas with the aim to help policy decision makers. It also underlines the importance of identifying key sources of financing and of assessing financial sustainability.The paper reviews the evidence on costing interventions to improve health workforce recruitment and retention in remote and rural areas, provides guidance to undertake a costing evaluation of such interventions and investigates the role and importance of costing to inform the broader assessment of how to improve health workforce planning and management.ResultsWe show that while the debate on the effectiveness of policies and strategies to improve health workforce retention is gaining impetus and attention, there is still a significant lack of knowledge and evidence about the associated costs. To address the concerns stemming from this situation, key elements of a framework to undertake a cost analysis are proposed and discussed.ConclusionsThese key elements should help policy makers gain insight into the costs of policy interventions, to clearly identify and understand their financing sources and mechanisms, and to ensure their sustainability.

The “attraction paradigm” proposed that demographic and experiential homogeneity will lead to effective group working, whereas disparity will have the opposite effect. There is evidence to suggest that demographically and experientially homogenous peer and volunteer health care workers (who may have had similar substance misuse and other experiences to the client groups with which they are working) contribute effectively towards positive health care outcomes. Professional health care workers, on the other hand, are not likely to be as demographically and/or experientially homogenous and have been shown to have negative attitudes towards substance misuse service users. It is suggested that by employing the arts, literature and music in substance misuse education, professional health care workers will be exposed to vivid and stark accounts of those experiences that they otherwise might not have, thus improving attitudes and perhaps, clinical outcomes.

Afghanistan has the second lowest health workforce density and the highest level of rural residing population in the Eastern Mediterranean Region. Ongoing insecurity, cultural, socio-economic and regulatory barriers have also contributed to gender and geographic imbalances. Afghanistan has introduced a number of interventions to tackle its health worker shortage and maldistribution. This review provides an overview of interventions introduced to address the critical shortage and maldistribution of health workers in rural and remote Afghanistan. A review of literature (including published peer-reviewed, grey literature, and national and international technical reports and documents) was conducted. The attraction and retention of health workforce in rural and remote areas require using a bundle of interventions to overcome these complex multidimensional challenges. Afghanistan expanded training institutions in remote provinces and introduced new cadres of community-based health practitioners. Targeted recruitment and deployment to rural areas, financial incentives and family support were other cited approaches. These interventions have increased the availability of health workers in rural areas, resulting in improved service delivery and health outcomes. Despite these efforts, challenges still persist including: limited female health worker mobility, retention of volunteer community-based health workforce, competition from the private sector and challenges of expanding scopes of practice of new cadres. Afghanistan made notable progress but must continue its efforts in addressing its critical health worker shortage and maldistribution through the production, deployment and retention of a "fit-for-purpose" gender-balanced, rural workforce with adequate skill mix. Limited literature inhibits evaluating progress and further studies are needed.

As highlighted by the 2006 World Health Report, Nigeria is one of 36 sub-Saharan African countries in the midst of a health workforce crisis. Inadequacy of optimal numbers of health workers with the appropriate skills-set is most pronounced in the rural and remote regions of Nigeria where 52% of the population live. Mortality and morbidity data from limited surveys of Nigeria indicate greater unmet health needs in rural and remote regions than in urban areas. Spartan living conditions, non-existent rural workforce policies and strategies, and an inadequate number of health staff with skills appropriate to the health priorities of rural areas are several of the many factors attributable to the steady decline in Nigeria's rural and remote health system. Based on 7 years' experience as a public health physician in rural and remote northern Nigeria, the author provides a perspective on factors hindering health workforce recruitment and retention, and proposes approaches to sustainably improving the current unsatisfactory health workforce situation in Africa's most populous nation. This article posits that out-migration of health workers is not a critical contributor to health workforce shortages in Nigeria's rural and remote areas. More important factors include contraction of government health spending as a percentage of GDP despite deteriorating health conditions, public health management systems that operate by default rather than by design, spartan living conditions outside urban areas, inadequate training of appropriate cadres of health staff, limited facilities and medications for effective delivery of clinical services, and burnout of overworked and underpaid rural-based clinicians. Most current health policy and strategy documents in Nigeria do not adequately account for the unique demographic features and health issues which vary according to remoteness from major cities. Addressing rural and remote health workforce shortages in Nigeria should begin with the development of a well-researched national rural and remote health strategy. Sub-optimal leadership and management at all levels of the public health sector, poverty, low motivation, inadequacy of health facilities and medications for effective delivery of health care, inadequacy of funding to employ qualified health staff, and primitive living conditions constitute major disincentives for skilled health workers to work in the rural and remote regions of Nigeria, and for declining productivity among existing health workers. Practical interventions to encourage recruitment and retention, and to assure improvements in the quality and popularity of appropriately designed training programs for health professionals needed in rural and remote regions of Nigeria are discussed. A need is highlighted for adequate planning and resource allocation to enable a systematic overhaul of encumbrances currently impacting on Nigeria's rural and remote health system. Lessons that may be adapted from successful rural and remote health workforce training and recruitment strategies in Tanzania are discussed.

Aim: Evaluate the prevalence of depression among professional healthcare workers (PHCW) during the COVID-19 pandemic. Methods: A cross-sectional study was conducted during the fourth wave of COVID-19 infection in Iraq. A semi-structured questionnaire in English was used to obtain information about the study variables. Results: The study included 314 participants, with a mean age of 34.3 years, slightly higher male to female sex (55.1 to 44.9%), doctors represent (26.1%), pharmacist represent (26.4%) while 36.9% includes other PHCW (nurse, laboratory technician, doctor assistance, and paramedics). There was a high prevalence of depression in the current study (98.4%). There was no significant association between total HADS with sex, specialty, and duration of working in COVID-19 isolation wards. Meanwhile, age above 50 years appears to be associated with higher HADS scores compared to younger PHCW. Conclusion: Healthcare practitioners faced a heightened susceptibility to experiencing depression throughout the COVID-19 pandemic.

PurposeThe desirability of having a more flexible workforce is emphasised across many health systems yet this goal is as ambiguous as it is ubiquitous. In the absence of empirical studies in healthcare that have defined flexibility as an outcome, the purpose of this paper is to draw on classic management and sociological theory to reduce this ambiguity.Design/methodology/approachThe paper uses the Weberian tool of “ideal types”. Key workforce reforms are held against Atkinson’s model of functional flexibility which aims to increase responsiveness and adaptability through multiskilling, autonomy and teams; and Taylorism which seeks stability and reduced costs through specialisation, fragmentation and management control.FindingsAppeals to an amorphous goal of increasing workforce flexibility make an assumption that any reform will increase flexibility. However, this paper finds that the work of healthcare professionals already displays most of the essential features of functional flexibility but many widespread reforms are shifting healthcare work in a Taylorist direction. This contradiction is symptomatic of a failure to confront inevitable trade-offs in reform: between the benefits of specialisation and the costs of fragmentation; and between management control and professional autonomy.Originality/valueThe paper questions the conventional conception of “the problem” of workforce reform as primarily one of professional control over tasks. Holding reforms against the ideal types of Taylorism and functional flexibility is a simple, effective way the costs and benefits of workforce reform can be revealed.

Changing the health care workforce: lessons from foundation-sponsored programs.

in the research of different professional curriculum proportion setting and employment relations in colleges game design courses, due to the single designed curriculum content when using the current algorithm to make different professional curriculum proportion setting, the error of proportion setting is big. To this end, a design method based on the improved game theory is proposed to design the different professional curriculum proportion setting and employment relations in the college game design courses. in the method, it is from the corresponding point of view of game design course in colleges and different professional curriculum to set up revenue function firstly, and different cost function is established according to the game design course in colleges and the teaching content and direction of employment development of different professional curriculum, to design the game model of professional curriculum proportion setting and employment relationship on the basis of this, promoting the different professional curriculum proportion setting in game design courses in colleges, and through the game Nash equilibrium, it is converged to the direction of employment development trend, and effectively to complete the design of different professional curriculum proportion setting and employment relations in game design course in colleges finally. The experimental simulation shows that the design method for different professional courses proportion setting and employment relations in the college game design course based on the improved game theory has a high accuracy and good effect.

The constitution of Nepal (2015), article 35 (Right relating to health) stated that every citizen shall have the right to free basic health services from the State, and no one shall be deprived of emergency health services. According to the World Bank report (collection of development indicators compiled from various official sources, 2016), Nepal has 81% rural and remote populations. Health service delivery is a complex reality for the rural and remote populations and faces enormous challenges. One of them is insufficient and uneven distribution of health workforce. The World Health Report concluded that "the severity of the health workforce crisis is in some of the world's poorest countries, of which 6 are in South East Asia out of 57 countries having critical shortages of health workforce."1Even after 13 years situation has not much improved. Nepal faces a critical shortage of trained health workforce, especially in rural and remote areas. Health workforce recruitment and retention in rural and remote areas is a difficult task challenged by the preferences and migration of health workforce to urban areas in country, or even abroad for better life and professional development.2 One of the most effective strategies for health workforce recruitment and retention for rural and remote areas could be that of establishing and maintaining Medical Education in rural and remote areas decentralized from urban academic medical centers.

Job characteristics, personal characteristics and well-being of nursing assistants in long-term care facilities: A mixed methods systematic review and narrative synthesis

As part of a study to determine Mycobacterium tuberculosis infection rates among medical students in Johannesburg South Africa we conducted tuberculin skin testing (TST) as well as HIV counselling and testing (in order to interpret TST results). We offered participation to 190 5th-year medical students; only 74 (39%) participated and none were HIV infected. The mean age of the participants was 23.9 years (median 23 years) and 55% were female. In two studies on HIV prevalence in South African health care workers the HIV testing was anonymous and unlinked i.e. participants could not learn their HIV status. We offered pre- and post-test HIV counselling and all participating students elected to receive their HIV results. While both studies included health care workers neither included medical students. Shisana et al. used cluster methods to sample a representative 5% of all health care workers in South Africa. Most (595 out of 721 or 82.5%) eligible health workers participated; 349 (59%) were professional health care workers (physicians and nurses) and 246 (41%) were non-professional (N=246) health care workers (ward attendants and cleaners). The HIV prevalence rate was 20.3% among non-professional workers and 13.7% among health professionals. HIV prevalence was higher among the 18 - 35-year-olds (20%) than among the 36 - 45-year-olds (16.6%). The HIV prevalence rate was not listed separately for different categories of professional health care workers. Connelly et al. determined the HIV prevalence among doctors nurses and student nurses at two hospitals in Gauteng province South Africa.2 While they achieved a high overall response rate (1 493/1 813 or 82.3%) almost all (98.5%) student nurses but few (25%) physicians participated. The HIV prevalence rate was 11.5% overall (student nurses 13.8% nurses 13.7% physicians 2%). HIV prevalence was low in hospital workers in the age groups over 55 years (2%) and 18 - 24 years (6.7%) and higher (10.2 - 15.9%) in all other age groups. The low participation rate among medical students in our study (39%) was higher than the 25% participation rate among physicians in the study by Connelly et al. even though HIV testing in our study was not anonymous. We expected to find an HIV prevalence rate among medical students similar to the estimated 9% to 11.9% for Gauteng youth aged 15 - 24 years. The lower rate among physicians in the study by Connelly et al. and in our study among medical students may suggest that physicians and medical students are truly at lower risk compared with the general population and other health workers or may be a biased estimate result with only those at lowest risk choosing to participate. These observations raise several questions. Why do physicians and medical students refrain from participation in these studies? Is the HIV prevalence among physicians and medical students truly lower than in the general population and other health workers? Does the low participation rate among physicians and medical students who are well aware of the HIV epidemic and the need for all South Africans to know their HIV status indicate that it may be difficult to achieve high uptake rates of HIV testing strategies in the general population? It is important to explore these questions further. (full-text)

The purpose of this paper is to investigate the impact of recent outsourcing and public-private partnership (PPPs) arrangements on the consistency of professional employment in health care. A case study methodology is applied. The paper finds that multiple arrangements for employment within the ISTC creates numerous sources for inconsistency in employment: across the workplace, within professional groups and with national frameworks for health care employment. These are identified as having implications for organisational outcomes, threatening the stability of current partnerships, and partially stymieing intended behavioural change. The study is a single case study of an independent sector treatment centre. Future research is required to investigate wider trends of employment in heterogeneous outsourcing and PPP arrangements. The paper informs both managers and clinical professionals of the unanticipated complexities and practical challenges that can arise in partnerships and outsourcing arrangements. The paper presents a unique in-depth investigation of employment within recently established ISTCs, and highlights important employment changes for the core health care workforce and high-status professionals in the evolving health care organisational landscape.

In this article old versus new production concepts (NPCs) and employment relation instruments, are studied, separately and in combination, to find out which yield high employee performance and low job strain. Therefore, in 2005, TNO conducted coupled surveys among 149 supervisors and employees. In the past decades, in reaction to dysfunctions of Tayloristic and professional bureaucratic production concepts and employment relations, several new forms of employment relations and NPCs, appeared. Examples are the Socio-technical NPC and customized employment relations. In this study both this NPC and customized employment relations - i.c. customized performance targets - demonstrate positive associations with employee performance. According to Socio-technical theory the design of employment relations is relatively unimportant, as human resources are mobilised primarily by the production concept. Our results for this NPC show the legitimacy of this assumption, because its high employee performance is irrespective of the employment relation instruments. On the contrary, in the other NPCs and in professional bureaucracies, the (employment relation) instruments of respectively an increased period needed for learning the job, and customized performance targets can compensate for the lower employee performance in these production concepts. The results do not show increased job strain, due to new production concepts, or new employment relations. production concepts, employment relations, labour productivity, socio-technical theory

Burnout can be defined as a long-term reaction to occupational stress which involves, particularly, the helping professions. The main aim of this study was the assessment of burnout in a sample of professional and voluntary health care workers and comparison of the two samples on scores from the Maslach Burnout Inventory. Analysis suggests a significant difference in mean scores for Emotional Exhaustion of volunteers vs professional workers. Some evidence has supported the hypothesis of a fourth dimension, called Behavioral Exhaustion, in the burnout syndrome.

Aim: This article aims to present a study protocol that represents a tool developed for a learning needs assessment. With a pilot study, based on the presented concept of a model study, we will be able to assess what mental health learning content is not yet part of formal higher education for professionals working in community mental health centres, but has been identified as necessary for inclusion. The presented tool is transferable with appropriate modifications. The goal is to conduct multiple research with the same basic tool at all levels of the educational system and in continuing professional education for all professionals who work with people. Methods: The learning needs assessment study protocol presented uses both quantitative and qualitative research approaches. It is expected that the research will be conducted in several interrelated phases that holistically cover the needs assessment process. Results: The pilot study will provide insight into the advantages and disadvantages of the prepared learning needs assessment tool. Through the research study, the learning needs of professionals working in community mental health centres, will be identified. Conclusion: Professional mental health care workers must be equipped with the necessary knowledge, skills, attitudes, and values to perform their work with quality. By implementing appropriate mental health learning content in educational processes from pre-school education to higher education and further to continuing professional education, we can impact the mental health of the entire population. Since this can lead to acquiring the competencies necessary to care of one’s own mental health and that of others, it can be considered an important public health intervention.