Frontline Workforce Research Articles

Talent Management in Healthcare: The New Strategic Objective

In today’s rapidly evolving healthcare landscape, effective talent management has become a critical priority for any organization seeking exceptional and safe care, whilst driving a positive outcome and impact in people’s lives. This article delves into the intricacies of talent management in healthcare, from an operational standpoint, aiming to capture how the frontline workforce perceives talent management. It is hypothesized that by implementing comprehensive talent management strategies, healthcare institutions would be able to address the current challenges posed by the worldwide workforce shortages. The increasing demand for healthcare services has prompted organizations and governments to proactively approach talent management to attract and retain the right individuals with the right skills to remain competitive and even functional. Employee engagement initiatives, along with a robust culture of continuous learning and phycological safety, where individuals can be at optimal performance and positively impact patient experience and outcome, significantly reduce turnover rates and ensure workforce stability (Dyrbye et al., 2017).

Piecing together Pakistan's health system and global health security.

Pakistan's health system has a critical role to play in global health security, however, it faces numerous structural and systemic challenges while contributing to international health efforts. Understanding the dynamics of health system is essential for developing effective strategies to prevent, detect, and respond to health emergencies, ensuring regional stability, and the overall global health security This paper documents the strengths and weaknesses of Pakistan's health systems, the impact of the COVID-19 pandemic, challenges such as funding constraints and fragmented healthcare delivery, threats including antimicrobial resistance, and the importance of international collaboration. Anti-microbial particularly multi-drug resistance, food safety in emergencies, surge capacity of the frontline workforce, patient safety at the health care facilities to curtail healthcare associated infections, and strengthening the points of entry are still the areas that need special attention. To optimise the system's performance, governance and accountability mechanisms are necessary to be put in place under the auspices of national public health agency. Pakistan has the potential to transform its health system by addressing these critical areas and improve its preparedness and readiness for any future health emergency of this scale.

Unraveling the impact of customer mistreatment on highway toll collectors' turnover intentions: the roles of stress symptoms, affective commitment, and neuroticism.

In the service industry, highway toll collectors serve as a distinctive frontline workforce who frequently encounter mistreatment from customers. Unfortunately, these behaviors have not received the attention and resolution they deserve, resulting in significant physical and psychological stress for toll collectors and exacerbating turnover rates. The study highlights how customer mistreatment affects toll collectors' turnover intentions by performing the sequential mediating roles of stress symptoms and affective commitment and assumes that neuroticism exacerbates the stress symptoms resulting from customer mistreatment based on affective events theory. The model was tested using data collected from 230 highway toll collectors in Zhuhai, China. All hypotheses received support. This study holds both theoretical and practical implications for future research.

Addressing the health human resources crisis: Strategies for retaining women health care professionals in organizations.

Globally, healthcare systems are contending with a pronounced health human resource crisis marked by elevated rates of burnout, heightened job transitions, and an escalating demand for the limited supply of the existing health workforce. This crisis detrimentally affects the quality of patient care, contributing to long wait times, decreased patient satisfaction, and a heightened frequency of patient safety incidents and medical errors. In response to the heightened demand, healthcare organizations are proactively exploring solutions to retain their workforce. With women comprising over 70% of health human resources, this study seeks to gain insight into the unique experiences of women health professionals on the frontlines of healthcare and develop a conceptual framework aimed at facilitating organizations in effectively supporting the retention and advancement of women in healthcare frontline roles. We used grounded theory in this qualitative study. From January 2023 to May 2023, we conducted individual semi-structured interviews with 27 frontline HCWs working in Canada and representing diverse backgrounds. The data underwent thematic analysis, which involved identifying and comprehending recurring patterns across the information to elucidate emerging themes. Our analysis found that organizational, professional, and personal factors shape women's intentions to leave the frontline workforce. Reevaluating organizational strategies related to workforce, fostering a positive work culture, and building the capacity of management to create supportive work environment can collectively transform the work environment. By creating conditions that enable women to perform effectively and find satisfaction in their professional roles, organizations can enhance their ability to retain valuable talent.

Ensuring Continuity of Health Professions Training Amid a Global Pandemic: Lessons From the Uganda Safe Schools Initiative.

Uganda experienced 2 COVID-19 waves that challenged health professional education. All health professions training institutions (HPTIs) in Uganda closed in March 2020. Cognizant of the threat to quality education and the frontline workforce, the National Council for Higher Education (NCHE) and Seed Global Health partnered to examine the risks and benefits of HPTI reopening through the Safe Schools Initiative (SSI). This article described the processes to unify stakeholders in health professions education and the outcomes from these discussions during the COVID-19 pandemic in Uganda.During the first COVID-19 wave, the SSI conducted consultative meetings with key stakeholders. The SSI developed guidelines around student welfare and issued standard operating procedures (SOPs) for HPTI reopening. The NCHE recommended in-person learning for final-year students and online learning for junior years, resulting in HPTIs being the first academic institutions to reopen in the country. During the second COVID-19 wave, schools closed again. The SSI utilized recently published literature and quantitative data to inform decision making in addition to expert consensus. The NCHE recommended immediate phased reopening for students in clinical years, blended learning for nonclinical years, and prioritizing health professions education in future lockdowns. Consequently, HPTIs reopened within a month of closure. The SSI demonstrated that national advocacy for health professions education can be effective when engaging stakeholders to build consensus around difficult decisions.Key lessons learned from the SSI include the following: (1) collaborating across sectors in health professions education can amplify change, (2) occupational health guidelines must include health professions students, (3) investing in online education and simulation has value in outbreak-prone areas, and (4) systemic inequities in health professions education will require persistence and advocacy to correct. Future pandemic preparedness must prioritize HPTIs to ensure quality education and continuity of a frontline workforce.

Emerging costs in a "hidden" workforce: The longitudinal psychosocial effects of caregiving during the COVID-19 pandemic among Norwegian adults.

During COVID-19 many informal caregivers experienced increased caregiving load while access to formal and informal support systems and coping resources decreased. Little is known about the psychosocial costs of these challenges for an essential yet vulnerable and "hidden" frontline workforce. This study explores and compares changes in psychosocial well-being (psychological well-being, psychological ill-being, and loneliness) before and across up to three stages of the COVID-19 pandemic among caregivers and non-caregivers. We also examine predictors of psychosocial well-being among caregivers during the peak of the pandemic. We use longitudinal data collected online in the Norwegian Counties Public Health Survey (age: 18-92) in four counties and up to four data points (n = 14,881). Caregivers are those who provide care unpaid, continuous (≥ monthly across all time points) help to someone with health problems. Findings show that levels of psychosocial well-being first remained stable but later, during the peak stages of the pandemic, dropped markedly. Caregivers (13-15% of the samples) report lower psychosocial well-being than non-caregivers both before and during the pandemic. Caregivers seem especially vulnerable in terms of ill-being, and during the peak of the pandemic caregivers report higher net levels of worry (OR = 1.22, p < 0.01) and anxiety (OR = 1.23, p < 0.01) than non-caregivers. As expected, impacts are graver for caregivers who provide more intensive care and those reporting health problems or poor access to social support. Our study findings are valuable information for interventions to support caregivers during this and future pandemics.

A resilient workforce: patient safety and the workforce response to a cyber-attack on the ICT systems of the national health service in Ireland

BackgroundIn May 2021, the Irish public health service was the target of a cyber-attack. The response by the health service resulted in the widespread removal of access to ICT systems. While services including radiology, diagnostics, maternity, and oncology were prioritised for reinstatement, recovery efforts continued for over four months. This study describes the response of health service staff to the loss of ICT systems, and the risk mitigation measures introduced to safely continue health services. The resilience displayed by frontline staff whose rapid and innovative response ensured continuity of safe patient care is explored.MethodsTo gain an in-depth understanding of staff experiences of the cyber-attack, eight focus groups (n = 36) were conducted. Participants from a diverse range of health services were recruited, including staff from radiology, pathology/laboratories, radiotherapy, maternity, primary care dental services, health and wellbeing, COVID testing, older person’s care, and disability services. Thematic Analysis was applied to the data to identify key themes.ResultsThe impact of the cyber-attack varied across services depending on the type of care being offered, the reliance on IT systems, and the extent of local IT support. Staff stepped-up to the challenges and quickly developed and implemented innovative solutions, exhibiting great resilience, teamwork and adaptability, with a sharp focus on ensuring patient safety. The cyber-attack resulted in a flattening of the healthcare hierarchy, with shared decision-making at local levels leading to an empowered frontline workforce. However, participants in this study felt the stress placed on staff by the attack was more severe than the cumulative effect of the COVID-19 pandemic.ConclusionsLimited contingencies within the health system IT infrastructure - what we call a lack of system resilience - was compensated for by a resilient workforce. Within the context of the prevailing COVID-19 pandemic, this was an enormous burden on a dedicated workforce. The adverse impact of this attack may have long-term and far-reaching consequences for staff wellbeing. Design and investment in a resilient health system must be prioritised.

Embedding psychological thinking within a local authority children and young people’s service; supporting, developing, and nurturing the workforce to work in a trauma informed way from the inside out

This article provides an overview of some of the psychologically informed practice of supporting young people, their families and the people supporting them within Children and Young People’s Services (CYPS) in Suffolk County Council (SCC). The overview outlines the approach and experiences of the Psychology Support Service (PSS; formerly known as Suffolk Family Focus Psychology Service). The PSS enables practitioners and managers across CYPS to access specialist psychological support to enable practitioners to support children, young people, and families with a range of needs. The PSS works closely with stakeholders including frontline practitioners, managers, and workforce development. The article, therefore, also includes reflections from practice management (Early Help) and workforce development management about psychological and trauma informed practice within CYPS. It is clear from the evidence, and from our own work within PSS, that working in a psychologically and trauma-informed way is important to meet the needs of vulnerable children and young people and those who are supporting them.The Psychology Support Service: Who we are, Why we do it and What we do.

Competencies of the UK nursing and midwifery workforce to mainstream genomics in the National Health Service: the ongoing gap between perceived importance and confidence in genomics.

The United Kingdom is recognised worldwide as a leader in genomics. The use of genomic technologies in the National Health Service (NHS) is expected to deliver faster and more accurate diagnoses, supporting personalized treatments to improve patient outcomes. The ambition of embedding genomic medicine in the diagnostic pathway requires involvement of the front-line clinical workforce, known as 'mainstreaming'. Nurses and midwives are the largest professionally qualified workforce in the National Health Service thus, it is anticipated that they will play key roles in mainstreaming. This study investigated the level of competence/confidence of practicing nurses and midwives to support mainstreaming and their perception of the importance of genomics in delivery of patient care. A literature review of genetics/genomics competency frameworks, semi structured interviews of lead nurses and stakeholders were conducted to identify relevant competencies needed for mainstreaming. These were then used to survey four cohorts of nurses (n = 153) across England in four consecutive years (2019-22). The confidence level of these professionals in all aspects of genomics was 2.07 ± 0.47 measured on a 5-point Likert scale (1"Low confidence"; 5 "High confidence"). Intriguingly, these professionals all appreciated the importance of genomics for their patient care (4.01 ± 0.06). Whilst the importance scores increased, the confidence scores declined at the time when major genomic transformation took place in the NHS (e.g.: launch of the Genomic Medicine Service, the National Genomic Test Directory). To bridge this gap, relevant genomic education can play key roles. However, nurses and midwives were found to be grossly underrepresented in formal genomic education courses offered by Health Education England Genomics Education Programme since 2014. This may result from the lack of direct applicability of the currently offered courses for their practice and role. Thematic analysis revealed that nurses and midwives wish to support their patients by providing more information on their condition, inheritance, and treatment options in combination with the use of relevant genetic counselling skills. This study identified easy to follow competencies for embedding genomics into routine clinical care. We propose a training programme that addresses the gap that nurses and midwives currently have, to enable them to harness genomic opportunities for patients and services.

"They Don't Really Consider Us Essential, But We Are": a Qualitative Investigation of Vaccine Acceptance and Perceived Workplace Safety Among Black Transit Workers During the COVID-19 Pandemic.

Black Americans face a higher risk of coronavirus disease 2019 (COVID-19) morbidity and mortality due to adverse social determinants of health, including their overrepresentation in the frontline workforce. Despite these inequities, increasing vaccine acceptance among this subpopulation has been challenging. We conducted semi-structured qualitative focus groups with Black public transit workers living in the USA to explore behavioral intentions regarding COVID-19 vaccine uptake, occupational health challenges, and the perceived impact of racism on workplace health and safety during the pandemic. A thematic analysis approach was used to analyze the final transcripts. We completed three focus groups (n=10 participants) in October and November of 2021. Enabling factors for vaccination included opportunities for vaccination in the workplace, flexible hours of operation, and walk-in vaccine clinics. Disabling factors included excessive wait times. Some participants also cited lack of cleanliness, inconsistent enforcement of COVID-19 safety protocols, and unclear workplace policies regarding sick and hazard pay as major safety barriers. Perceptions regarding the role of racism in their experiences with COVID-19 as transit workers were mixed. Though occupational health and safety concerns were high, there are opportunities for transit agencies and government officials to improve both vaccine uptake and working conditions for Black transit workers.

The EMN Salary Survey

The EMN Salary Survey

Understanding the multidimensional aspects of quality of work-life of Environmental Public Health Professionals in Canada

Environmental Public Health Professionals (EPHPs) are an essential frontline workforce that aims to keep the Canadian population healthy and safe. Our study explores the multidimensional aspects of work-life related Quality of Work (QoW) among EPHPs in Canada. A mixed-method cross-sectional online survey was used. The data collection was completed in September–October 2022 with 96 participants. The study included EPHPs such as Public Health Inspectors and Environmental Health Officers in Canada who are currently working in Canada and during the COVID-19 pandemic and managers/supervisors of EPHPs. Our Study results reveal that there have been significant challenges to ensuring QoW in work-life settings for EPHPs, ranging from negative attitudes from the employer, challenges with varying guidelines due to geographic locations of health authorities, and increased levels of workload leading to stress, anxiety, depression and burnout – all of which has affected the work-life balance and mental health and well-being of EPHPs.

Supply chains create global benefits from improved vaccine accessibility

Ensuring a more equitable distribution of vaccines worldwide is an effective strategy to control global pandemics and support economic recovery. We analyze the socioeconomic effects - defined as health gains, lockdown-easing effect, and supply-chain rebuilding benefit - of a set of idealized COVID-19 vaccine distribution scenarios. We find that an equitable vaccine distribution across the world would increase global economic benefits by 11.7% ($950 billion per year), compared to a scenario focusing on vaccinating the entire population within vaccine-producing countries first and then distributing vaccines to non-vaccine-producing countries. With limited doses among low-income countries, prioritizing the elderly who are at high risk of dying, together with the key front-line workforce who are at high risk of exposure is projected to be economically beneficial (e.g., 0.9%~3.4% annual GDP in India). Our results reveal how equitable distributions would cascade more protection of vaccines to people and ways to improve vaccine equity and accessibility globally through international collaboration.

A proactive learning approach toward building adaptive capacity during COVID-19: A radiology case study

The COVID-19 pandemic has challenged organizations to adapt under uncertainty and time pressure, with no pre-existing protocols or guidelines available. For organizations to learn to adapt effectively, there is a need to understand the perspectives of the frontline workforce involved in everyday operations. This study implemented a survey-tool to elicit narratives of successful adaptation based on the lived experiences frontline radiology staff at a large multispecialty pediatric hospital. Fifty-eight members of the radiology frontline staff responded to the tool between July and October of 2020. Qualitative analysis of the free-text data revealed five categories of themes that underpinned adaptive capacity of the radiology department during the pandemic: information flow, attitudes and initiative, new and adjusted workflows, availability and utilization of resources, and collaboration and teamwork. Enablers of adaptive capacity included timely and clear communication about procedures and policies from the leadership to frontline staff, and revised workflows with flexible work arrangements, such as remote patient screening. Responses to multiple choice questions in the tool helped identify the main categories of challenges faced by staff, factors that enabled successful adaptation, and resources used. The study demonstrates the use of a survey-tool to proactively identify frontline adaptations. The paper also reports a system-wide intervention resulting directly from a discovery enabled by the findings based on the use of RETIPS in the radiology department. In general, the tool could be used in concert with existing learning mechanisms, such as safety event reporting systems, to inform leadership-level decisions to support adaptive capacity.

Geographies of Frontline Workers: Gender, Race, and Commuting in New York City

The COVID-19 pandemic amplified social, economic, and environmental inequalities in American cities, including inequities in commuting and access to employment. Frontline workers—those who had to work on site during the pandemic—experienced these inequalities in every aspect of their daily lives. We examine the labor force characteristics and commuting of frontline workers in New York City with a focus on gender and race/ethnic disparities in wages and commuting modes and times. Using Census PUMS microdata for a sample of New York City residents in the 2015–2019 period, we identify frontline workers from detailed industry and occupation codes and compare characteristics of frontline workers with those of essential workers who could work remotely. The data highlight wide disparities between frontline and remote workers. Minority men and women are concentrated in the frontline workforce. The residential geographies of frontline and remote workers differ greatly, with the former concentrated in low- and moderate- income areas distant from work sites and with long commute times. Compared to men, women frontline workers rely heavily on public transit to commute and transit dependence is highest among Black and Latina women. Low-wage employment, long commute times, and transit dependence intersected to increase minority women’s economic and social vulnerability during the pandemic.

Organizational support and Nurse-Physician collaboration during SARS-CoV-2 pandemic: A qualitative study.

Health care professionals experienced multiple uncertainties during the pandemic. Exploring health care professionals' views about collaboration and organizational support can offer insights into organizational processes and issues during the pandemic. This research explored the perspectives of nurses and physicians about organizational support and nurse-physician collaboration during the SARS-CoV-2pandemic. Using a qualitative descriptive design, interviews were conducted with nurses and physicians working in hospital settings. The interviews lasted for 24-61 min. Reflexive thematic analysis was used for data analysis. Nurses and physicians were disappointed with the organizational support, but they were satisfied with nurse-physician collaboration. The theme "Management Abusing Authority and Blaming the Victimized Workforce" included organizational nepotism, unethical managerial actions, and neglecting frontline workforce. Nurses and physicians supported each other in tackling the intensive and complex demands of the pandemic. The theme "Demonstrating Professional Humility and Overcoming Patient Care Issues at Hand" entailed subthemes -negotiating conflicts and prioritizing patient care, practicing kindness, and jointly managing conflicts with patients' families. Nurses and physicians reported frustrations with limited organizational support and abusive practices of managers. Still, they prioritized patient care needs and family-related conflicts over interprofessional tensions.

Integration of occupational health and safety management, social responsibility of business, and sustainability: A stakeholder-based qualitative study on China’s electric power industry

Improving working conditions and promoting the health, safety and well-being of workers are highly relevant to the social responsibility of business and the sustainability of enterprises. This empirical study investigates the successes and barriers of the integration of occupational health and safety management (OHSM), corporate social responsibility (CSR), and sustainability in China’s electric power industry, with the combined theoretical framework of New St. Gallen Management Model and stakeholder theory. Semi-structured interviews were carried out among the internal, external and distal stakeholders (n=90), supplemented with on-the-spot observations. Through statistical and discourse analysis, it is found that the integration of OHSM, CSR, and sustainability has been achieved at the structural, operational, and organizational levels in China’s electric power industry, due to the fast development of technology and the legal system ensuring a good environmental sphere, with people-centered philosophy being highlighted. However, some deficiencies such as law reenforcement and the coherence between internal and external stakeholder management systems must be improved, particularly with respect to frontline workforce training. The communication of OHSM, CSR, and sustainability outside of the industry should also be enhanced for a better environmental sphere and public support.

Prevalence of SARS-CoV-2 infection among health care workers in a reference hospital in Brazil.

Health care workers (HCW) are the frontline workforce for COVID-19 patient care and, consequently, are exposed to SARS-CoV-2 infection due to close contact to infected patients. Here, we evaluate the prevalence of SARS-CoV-2 infection among HCW from an infectious disease hospital, reference center for COVID-19 care in the metropolitan area of Sao Paulo city, Brazil. Among 2,204 HCW, 1,417 (64.29%) were subjected to detection of anti-SARS-CoV-2 antibodies by chemiluminescent immunoassay. Out of the total, 271 (19.12%) presented anti-SARS-CoV-2 antibodies. Prevalence varied according to HCW categories. The highest prevalence was observed in workers from outsourced companies, cooks and kitchen assistants, hospital cleaning workers, and maintenance workers. On the other hand, resident physicians and HCW from the institution itself presented lower prevalence (nurses, nursing assistants, physicians, laboratory technicians). Social and environmental factors are important determinants, associated with exposure in the hospital environment, which can determine the greater or lesser risk of infection by pathogens that spread rapidly by air.

Extending health systems resilience into communities: a qualitative study with community-based actors providing health services during the COVID-19 pandemic in the Philippines

BackgroundAmidst ongoing calls for increased health systems resilience, gaps remain in our understanding of how health systems can reach further into communities to ensure resilient service delivery. Indeed, public health emergencies caused by infectious hazards reveal both the value and vulnerability of the workforce delivering health services in communities. This study explores ways in which a non-governmental organization (NGO) in the Philippines protected their frontline workforce during the first year of the COVID-19 pandemic.MethodsGuided by a qualitative descriptive approach, 34 in-depth interviews were conducted with community-based health actors employed by the NGO between June 2020 and February 2021. Data analysis was guided by an iterative deductive and inductive approach.ResultsWe identified four key activities that enabled the NGO and their staff to provide health and social services in communities in a safe and consistent manner as part of the organization’s pandemic response. These include (1) ensuring adequate personal protective equipment (PPE) and hygiene supplies; (2) providing contextualized and role-specific infection prevention and control (IPC) training; (3) ensuring access to testing for all staff; and (4) providing support during quarantine or isolation.ConclusionLearning from the implementation of these activities offers a way forward toward health emergency preparedness and response that is crucially needed for NGOs to safely leverage their workforce during pandemics. Further, we describe how community-based health actors employed by NGOs can contribute to broader health systems resilience in the context of health emergency preparedness and response.

Pakistan: Walking the Last Mile for Eradicating Polio – We are Stumbling

The pressure of disease eradication can be enormous. Pakistan and Afghanistan are 2 endemic countries that are expected to give the final push to Wild Polio Virus out of planet. Polio Eradication is the largest program the world has known and has the largest frontline workforce that knocks at every door in the country. Pakistan had 15 months period where no human paralytic case of wild polio virus was reported, the program was thought to be headed in the right direction when suddenly, the outbreak happened in northwest part of Pakistan with multiple paralytic cases clustered in time and space. It was only after the detection of these cases that program’s telescope turned to this part of Pakistan that had longstanding issues which were not unknown. The outbreak has now spread to other parts of Pakistan. In this article, the author narrates her experience from the field that highlight the issues with roots that penetrate deep in the systems and hamper not only the progress of Polio Eradication but also, why overall health investments do not reach masses adequately. The author also presents the solution(s) that need to be implemented by overturning “one size fits all approach”. This entails local policy making through firsthand community interaction instead of policies made in fancy offices far away from these communities.