Workforce Support Research Articles

How can we act now to create a high-quality support workforce in the UK's health sector? Pt 2/2

How can we act now to create a high-quality support workforce in the UK's health sector? Pt 2/2

Improving skills and care standards in the support workforce for older people: a realist synthesis of workforce development interventions

BackgroundSupport workers make up the majority of the workforce in health and social care services for older people. There is evidence to suggest that support workers are not deployed as effectively as possible, are often undervalued, and that there are gaps in understanding support worker roles across different care settings. In the context of a population that is growing older, having a skilled and knowledgeable workforce is an imperative. Workforce development includes the support required to equip those providing care to older people with the right skills, knowledge and behaviours to deliver safe and high-quality services.ObjectiveThe review answered the question ‘how can workforce development interventions improve the skills and the care standards of support workers within older people’s health and social care services?’.DesignA realist synthesis was conducted. In realist synthesis, contingent relationships are expressed as context–mechanism–outcomes (CMOs), to show how particular contexts or conditions trigger mechanisms to generate outcomes. The review was conducted in four iterative stages over 18 months: (1) development of a theoretical framework and initial programme theory; (2) retrieval, review and synthesis of evidence relating to interventions designed to develop the support workforce, guided by the programme theories; (3) ‘testing out’ the synthesis findings to refine the programme theories and establish their practical relevance/potential for implementation; and (4) forming recommendations about how to improve current workforce development interventions to ensure high standards in the care of older people.ParticipantsTwelve stakeholders were involved in workshops to inform programme theory development, and 10 managers, directors for training/development and experienced support workers were interviewed in phase 4 of the study to evaluate the findings and inform knowledge mobilisation.ResultsEight CMO configurations emerged from the review process, which provide a programme theory about ‘what works’ in developing the older person’s support workforce. The findings indicate that the design and delivery of workforce development should consider and include a number of starting points. These include personal factors about the support worker, the specific requirements of workforce development and the fit with broader organisational strategy and goals.Conclusions and recommendationsThe review has resulted in an explanatory account of how the design and delivery of workforce development interventions work to improve the skills and care standards of support workers in older people’s health and social care services. Implications for the practice of designing and delivering older person’s support workforce development interventions are directly related to the eight CMO configuration of the programme theory. Our recommendations for future research relate both to aspects of research methods and to a number of research questions to further evaluate and explicate our programme theory.LimitationsWe found that reports of studies evaluating workforce development interventions tended to lack detail about the interventions that were being evaluated. We found a lack of specificity in reports about what were the perceived and actual intended impacts from the workforce development initiatives being implemented and/or evaluated.Study registrationThis study is registered as PROSPRERO CRD42013006283.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

How can we act now to create a high-quality support workforce in the UK's health sector? Pt 1/2

How can we act now to create a high-quality support workforce in the UK's health sector? Pt 1/2

Communication rehabilitation in sub-Saharan Africa: A workforce profile of speech and language therapists.

BackgroundThere is an urgent global need to strengthen rehabilitation services for people with disabilities. In sub-Saharan Africa, rehabilitation services for people with communication disabilities continue to be underdeveloped. A first step in strengthening services for people with a communication disabilities is to understand the composition and conditions of the current workforce.ObjectivesThis research describes a sample of the speech and language therapists (SLTs) working in SSA (excluding South Africa). This study explores the characteristics of this workforce, including their demographics, education, experience and geographical stability.MethodA mixed-methods survey was used to collect data from SLTs within Anglophone countries of SSA. Completed surveys were received from 33 respondents working in 44 jobs across nine countries. Analysis included descriptive and non-parametric inferential statistics. This study reports on a subset of descriptive and quantitative data from the wider survey.ResultsA background profile of SLTs across the region is presented. Results indicated that the workforce of SLTs comprised a mix of local and international SLTs, with university-level education. Local SLTs were educated both within and outside of Africa, with more recent graduates trained in Africa. These data reflected the local emergence of speech and language therapy training in SSA.ConclusionThis sample comprised a mix of African and international SLTs, with indications of growing localisation of the workforce. Workforce localisation offers potential advantages of linguistic diversity and stability. Challenges including workforce support and developing culturally and contextually relevant SLT practices are discussed.

Physician Understanding and Treatment of Addiction: Have ‘Pseudoaddiction’ and ‘Self-Medication’ led us astray?

U.S. healthcare and psychiatry in particular, lack trained professional workforce, physical infrastructure, and financial support via insurance coverage needed to adequately support addiction treatment. Concepts of ‘pseudoaddiction’ and ‘self-medication’, influential among physicians who treat pain and/or mental illness, frame drug use as being therapeutically beneficial, which is different from, and even opposite to, how drug use is understood in the disease model of addiction. Over-emphasis on the closely-related concepts of ‘Pseudoaddiction’ and ‘self-medication’, especially in regard to patients who suffer addiction at high rates, may have contributed to a medical- psychiatric culture that has been slow to taking clinical responsibility for diagnosing, preventing, and treating addiction as a disease of major public health importance.

Teaching Data Analysis to the Data-Averse: A Framework for Educators

ABSTRACTIt remains a dilemma for social work educators to teach research so that it can be embraced by students as an integral part of social work practice. This article reports on an initiative to design a research course focused on the integration of research with practice. Drawing on developments in data mining and techniques in secondary data analysis, participating social work students gained experience in conducting analyses of existing data. The article presents the rationale for the nature of this teaching model and discusses both the challenges and benefits experienced by students, faculty, and agency-based staff. Access to agency practice data and workforce development, to parallel and support undergraduate competence, is recommended.

Antenatal and postnatal care: a review of innovative models for improving availability, accessibility, acceptability and quality of services in low-resource settings.

Key lessons can be drawn from innovative approaches that have been implemented to ensure access to better antenatal care (ANC) and postnatal care (PNC). This paper examines the successes and challenges of ANC and PNC delivery models in several settings around the world; discusses the lessons to be learned from them; and makes recommendations for future programmes. Based on this review, we conclude that close monitoring of ANC and PNC quality and delivery models, health workforce support, appropriate use of electronic technologies, integrated care, a woman-friendly perspective, and adequate infrastructure are key elements of successful programmes that benefit the health and wellbeing of women, their newborns and families. However, a full evaluation of care delivery models is needed to establish their acceptability, accessibility, availability and quality. New paper examines global innovations in antenatal/postnatal care @MHTF @ICS_Integrare #MNCH #healthsystems.

Social and emotional wellbeing, natural helpers, critical health literacy and translational research: connecting the dots for positive health outcomes.

The tripartite framework for principled practice was developed as part of the Wundargoodie Aboriginal Youth and Community Wellbeing Programme. The programme engages natural helpers to enhance critical health literacy. This paper examines the importance of translational research to enhancing critical health literacy for this group of de facto health workers using the work of the Australian Indigenous HealthInfoNet as an example. Translational research provides workforce support for those who are time poor and overburdened. Connecting these concepts and natural helpers will make a positive difference to Aboriginal health outcomes. There is a need for the development of translational research products that enhance the critical health literacy of natural helpers. The tripartite framework for principled practice supports reflective and accountable practice in the intercultural space to build trust and confidence between Aboriginal and non-Aboriginal people to enhance the opportunity for authentic knowledge production and transfer.

Changes in the Supply of US Rural Health Centers, 2000-2011: Implications for Rural Minority Communities.

Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) provide primary care in rural areas with a shortage of providers. This paper examines whether racial and ethnic minority composition was related to changes in the supply of RHCs and FQHCs in rural counties from 2000 to 2011. We conducted a retrospective cohort study of rural counties using the Area Health Resource File 2012-2013. We examined rural counties defined as non-Core-Based Statistical Areas, with complete data on county characteristics for the study period (N = 1,349). Logistic regression analyses estimated associations between percentage of minority residents, and net gains and losses of RHCs and FQHCs, adjusting for total population, percentage of elderly residents, infant mortality rate, poverty rate, and physician, hospital, and clinic supply. Model estimates were used to calculate the predicted probability of outcomes across a range of minority percentage, from the 10th (≤1.6%) to 90th (≥46%) percentile of rural counties. In high-minority counties, the predicted probability of a net gain in any type of clinic was 28.6% (95% CI: 21.3-35.8), versus 46.4% (95% CI: 40.0-52.8) for low-minority counties. High-minority counties were also more likely to experience a net decline in RHCs. During a period of substantial growth in both programs, the percentage of minority residents was negatively associated with gaining new clinics of either type. Policy makers may need to consider targeting rural minority communities for additional primary care workforce support.

How research-based is our policy-making? Implementation of evidence-based treatments by State behavioral health systems, 2001-2012

Despite the proliferation of evidence-based treatments (EBT), there is little evidence that they are successfully implemented in real world behavioral health systems, fueling an ongoing debate about whether and how systems should invest in infrastructure to support implementation of EBT and the use of data and research to inform policy. Ironically, however, there are few empirical studies of whether and how public systems are living up to the promise of data- and research-based decision-making. The current study used data from the National Association of State Mental Health Program Directors (NASHMPD) Research Institute's (NRI) longstanding effort to compile information on state mental health authorities to examine the degree to which state systems currently invest in EBT and data-driven decision-making, and how such investments have changed over the period from 2001-2012. The study focused on: (1) Rates of implementation of specific EBT programs; (2) Types of state-provided or-facilitated EBT training and workforce support; and (3) State investment in evaluation, data, and research use. Data originated from three NRI projects for which annual or semi-annual data relevant to the above research questions were available: the State Profiles System (SPS), the Revenues and Expenditures Study (R&E), and the Uniform Reporting System (URS). Results found that after an initial increase from 2001-2004, rates of implementation of both child and adult EBTs have been consistently flat for the last decade, with investment in EBTs for adults 2-6 times higher than for children's services. Data also show variability over time in the types of implementation supports being used, with states increasingly emphasizing EBT in contracts with providers, modification of IT systems, and awareness building, and less on specific budget requests for EBT implementation or financial incentives for EBT use. Of concern, state investment in research and evaluation capacity and database integration efforts appear to be decreasing. Results of this ongoing research initiative are intended to strengthen the D&I knowledge base on the use of research findings in public systems, informing future national priorities and state efforts, promoting additional research, and serving as a baseline metric for reform efforts.

SU‐E‐P‐19: A National Collaborative Academic Medical Physics Network: Structure, Activity and Outcomes

Purpose:A national Australian inter‐university medical physics (MP) group was formed in 2011/12, supported by Department of Health Better Access to Radiation Oncology BARO) seed funding. Core membership includes the six universities providing postgraduate MP courses. Objectives include increasing capacity, development and efficiency of national academic MP structures/systems and hence supporting education, clinical training and research, for the MP workforce support. Although the BARO scheme focuses on Radiation Oncology, the group has wider MP interests.Methods:Two further BARO seed grants were achieved: 1) for networked academic activities, including shared‐resource teaching, eg using virtual reality systems; MP outreach to schools and undergraduates; developing web‐based student and registrar education/resources, etc.; and 2) for conjoint ‘translational research’ posts between universities and partner hospitals, to clinically progress advanced RT technologies and to support students and registrars. Each university received 0.5 FTE post from each grant over 2 years (total: $1.75M) and leveraged local additional partner funds.Results:Total funding: $4–5M. Overall there have been 35 (mainly overseas) postholders bringing specific expertise, beginning in early 2013. Periods in Australia have been from 0.25–2 years (median=1). As well as the education activities, research projects include lung/spine SBRT, 4D RT, FFF beams, technology assessment, complex treatment planning, imaging for radiation oncology, DIR, adaptive breast, datamining, radiomics,etc. Observed positive impacts include: increased interest in MP courses, training support, translational research infrastructure and/or clinical practice in the hospitals involved, plus increased collaboration and effectiveness between the universities. Posts are continuing beyond grant end using leveraged funds, providing the basis for sustainability of some posts.Conclusion:The BARO‐funded projects have cost‐effectively produced a range of positive impacts on training, research and practice in hospitals and between universities. The evaluation of the specific post roles and activities, and their outcomes, has produced focused recommendations on continuation and sustainability.Funding was from the Australian federal Department of Health; leveraged funding was from partner universities and hospitals

A randomised controlled trial of a relationship support training programme for frontline practitioners working with families

This article presents findings from a cluster randomised controlled trial of a ‘blended’ (online and face-to-face) training programme for frontline practitioners (n = 222 intervention group, n = 227 control group). The ‘Relationship Support: An Early Intervention’ programme aimed to help practitioners recognise, respond appropriately to and review the need for further support for people experiencing relationship difficulties. Within a three-month time interval between the intervention and outcome measurement, the training had a significantly large positive impact on the way practitioners handled conversations with parents about their relationship difficulties. Practitioners in the intervention group reported being more than twice as likely as those in the control group to be confident in knowing both where and how to refer parents on for further support. The training also increased the likelihood of offering equivalent support in the future. These positive outcomes were evident across the sample, irrespective of practitioners’ pre-intervention level of experience or confidence. Implications of this study are outlined in terms of training the relational capability of the wider family support workforce.

Investigation of Quality Benefits of ERP Implementation in Indian SMEs

Abstract ERP (Enterprise Resource Planning) systems are now viewed as powerful information technology solution for SMEs (Small and Medium scale Enterprises) in India, in order to remain competitive in the global knowledge based business. ERP paves a good path to streamline the internal and external processes of enterprise and promotes qualitative development in the work and work process.This paper systematically investigates effects of training, project management, hardware and software, skills of workforce and top management's support on quality aspects. For this investigation data is collected from 95 SMEs in India. Factor analysis is carried out to ensure different types of validities. Further effect of each factor on quality aspect is analysed with the help of regression model. Analysis clearly gives the insight about relative importance of various factors affecting Quality aspects and prioritises them to achieve maximum quality benefits.

Lifting the burden: a coordinated approach to action on Aboriginal tobacco resistance and control in NSW.

Smoking prevalence continues to be significantly higher among Aboriginal people than non-Aboriginal people, resulting in a range of serious health consequences and inequities. The Aboriginal Health and Medical Research Council of New South Wales (AHandMRC) and the New South Wales (NSW) Ministry of Health (the Ministry) have worked in partnership to develop The ATRAC Framework: A Strategic Framework for Aboriginal Tobacco Resistance and Control in NSW, in collaboration with Aboriginal communities and a range of stakeholders. The goal of the ATRAC Framework is to reduce smoking prevalence and the harmful impacts of tobacco use among Aboriginal people and communities in NSW. The framework includes reviews of relevant evidence and recommended actions, organised under six areas: leadership, partnerships and coordination; community action, awareness and engagement; workforce development; supportive environments; quitting support; and evidence, evaluation and research. The framework stresses that, to be successful, Aboriginal tobacco resistance and control programs and activities need to be evidence based, coordinated, integrated and involve Aboriginal people and Aboriginal community controlled health organisations in all aspects, from development through to implementation and evaluation. Consultations and evidence reviews highlight the importance of workforce support and development, including the ongoing need for more workers specialising in Aboriginal tobacco resistance and control, as well as ongoing training for all staff involved in delivering care to Aboriginal people. Other key strategies identified in the framework include improving access to nicotine replacement therapy and other medications to support quitting; supporting, strengthening and building on existing innovative community-based programs; and further developing the evidence base. The AHandMRC and the Ministry will continue to work in partnership to drive the use of the ATRAC Framework by all people involved in Aboriginal tobacco resistance and control in NSW for resource allocation, planning, implementation and evaluation of existing and future activities.

Nurse perceptions of workplace environment: differences across shifts.

To evaluate whether nurse work shift affected workplace perceptions. Although the importance of work schedule in shaping work attitudes, generally (and specifically for nurses) is well accepted, much work remains in characterising how and why nurses' perceptions might differ across shifts. Using an exploratory study of observational data, we examined whether shift influenced non-supervisory nurses' job perceptions in the Veterans Health Administration All Employee Survey (n=14057; years 2008, 2010, 2012). The size of differences in item means (95% C.I.) across shifts was evaluated graphically. Using ordinal logistic regression, we accounted for the ordinal outcome variables and controlled for the demographic and survey year effects. Nurses' perceptions of workplace climate differed across shifts. Items with the greatest differences, consistent across years and analytic methods, involved supervisors and fairness. Night and weekend shift nurse ratings were more negative than for weekday shift nurses. Off-shift nurses are less satisfied with work/life balance, their supervisors and especially fairness. Overall satisfaction and turnover intention are not affected to the same extent. These results indicate several specific areas that nurse managers can address through workforce support and communication.

Direct Support Workforce Supporting Individuals With IDD: Current Wages, Benefits, and Stability

Abstract Direct support professionals (DSPs) and frontline supervisors (FLSs) play an integral role in the lives of people with intellectual and developmental disabilities (IDD) and are often the individuals directly responsible for assisting people with IDD to live and fully participate in their communities. These two groups of workers have typically been employed at lower wages with limited access to fringe benefits, contributing to high rates of turnover compared to a similarly skilled worker in the United States. This article summarizes findings and is the first investigation in several years to systematically examine the wages, fringe benefits, and stability of the DSP and FLS workforces supporting individuals with IDD. Findings suggest that a typical DSP may expect to earn about $11.25 per hour, while FLSs may expect wages of about $15.45 hourly. Of concern, however, is that fringe benefit provision was quite limited in this sample. Implications, including relation to past reports of DSP workforce development, are discussed.

Developing a high-performance support workforce in acute care: innovation, evaluation and engagement

Developing a high-performance support workforce in acute care: innovation, evaluation and engagement

HCAs transform patients' experience of care through Macmillan Cancer Support's Values Based Standard

The Macmillan Values Based Standard aims to achieve a transformation in patients' and families' experience of care. Importantly, the standard provides a framework and methodology for improving both patient and staff experience. Of all health professionals, healthcare assistants (HCAs) spend the most ‘face-time’ with patients and are therefore crucial in the drive to transform patients' experience of care. HCAs have contributed to the implementation of the Values Based Standard in a number of Macmillan pilot sites and they have demonstrated how the framework can help drive improvement. Macmillan believes HCAs are key to changing the way patients and their families experience care. For this reason, Macmillan is investing in testing a new development programme, designed specifically to support HCAs, while also ensuring that the organisations they work within focus on the Values Based Standard and provide workforce support to HCAs. This article introduces the programme.

Improving skills and care standards in the support workforce for older people: a realist review

IntroductionIn the context of a population that is growing older, and a number of high-profile scandals about care standards in hospital and community settings, having a skilled and knowledgeable workforce...

Effect of a New Social Support Program by Voluntary Organization in Pediatric Oncology Department in a Developing Country

Comprehensive childhood cancer treatment in the modern era means not only strenuous treatment regimens and meticulous nursing care, it also implies attention to social, psychological, and financial aspects of disease and treatment. In a developing country like ours, though it is possible to provide good medical and nursing care in government set-up, there is always shortage of workforce and financial support, leading to nonadherence to treatment regimens by patients and parents, resulting in suboptimal treatment outcomes. Overcrowding of pediatric cancer patients along with general patients for lab tests and other hospital services, poor drug compliance, treatment abandonment, and lost to follow-up, lack of funding to meet nonmedical expenses and inadequate facility for providing psychological support were some of the major reasons we could identify as lacunas in our pediatric oncology division (POD). We introduced a new social support program with the help of additional staff supported by a nongovernmental agency, and new quality improvement services were introduced. The impact was demonstrable as reduction in waiting time in the hospital, allayed anxiety of painful procedures, better drug compliance, less treatment abandonment, and improved follow-up. This can be emulated in similar other resource-limited centers.