Workforce Capacity Research Articles

4.B. Workshop: Addressing backlogs and managing waiting lists during and beyond the COVID-19 pandemic

Abstract As COVID-19 cases started to rise in early 2020 and hospitalisation rates increased, health systems began to postpone non-emergency (elective) procedures to keep capacity available for COVID-19 patients, and to avoid elective patients being infected. This has subsequently led to longer waiting lists and waiting times in virtually all countries. Issues around staff recruitment and retention, which have been exacerbated by the COVID-19 pandemic, have further aggravated the problem. For patients with common elective surgeries, such as hip and knee replacements, the backlog in care means that improvements in health and quality of life are postponed. For urgent care, such as missed chemotherapy sessions for cancer care, the delays can have more severe consequences. For other patients, the postponement of specialist appointments may lead to missed referrals for serious ailments. Increasingly also primary care has become affected leading to late diagnosis of chronic diseases, as well as inadequate follow up and control of these patients. Each delay in diagnosis and treatment may worsen health problems, prolong recovery and decrease the patients’ chances of survival. Countries are now left playing catch-up on these backlogs. There is however great uncertainty regarding the size of the backlogs, how much current and future capacity will be required to address them, and how much provider and workforce capacity will be needed for COVID-19 patients which will detract capacity for non-COVID patients. If health systems do not manage to reduce the backlog, they risk worsening health outcomes and wasting important health gains made in the last years. This workshop will discuss what we know about (1) the level of service disruptions and resulting backlog, (2) the drivers of backlog, and (3) which policies countries are using to address this. The workshop will conclude with an audience discussion about how to measure the true size of the backlog, the policy options for overcoming backlog and key priorities for further research. Key messages • The COVID-19 pandemic has led to substantial disruptions in care delivery leading to care backlogs in virtually all countries. • Countries have various policy options to tackle backlogs and bring down waiting times in the wake of the pandemic.

Health workforce needs of small medical specialties: findings from rheumatology in Germany

Abstract Background Small medical specialties may be more vulnerable to workforce shortage and the COVID-19 pandemic and this may directly impact in the provision of care for chronically-ill patients. This study aims to explore health workforce development and new needs, using rheumatology in Germany as a case study. Methods An explorative multi-methods approach was applied, combining health labour market assessment of rheumatology physicians (public statistics 2000-2019) and a questionnaire-based online survey conducted in early 2021 (n = 101 respondents; rheumatology physicians and residents). Main selected topics: work hours, workload, mental health issues, discrimination and sexual harassment experiences, impact of COVID-19. Descriptive statistical analysis was performed and qualitative content analysis for free-text information. Results Health labour market analysis showed that the numbers of rheumatologists increased markedly between 2000 and 2019 in the groups aged +50 years, but only 9% in younger groups under 50 years; since 2010 the group 40-50 years showed decreases. In 2019, the absolute number of rheumatologists working in healthcare after retirement-age exceeded those aged 40 and under. Survey data revealed a strong mismatch between actual and desired work hours for women and men. 81% rated their workload as high or very high; every sixth rheumatologist has suffered from stress or burnout syndromes at least once in the past. Experiences of gender discrimination and sexual harassment/violence were frequently reported, mostly by women. COVID-19 was an amplifier of stress with major stressors being digitalisation and increased demand for communication and patient education. Conclusions Decreasing health workforce capacities in German rheumatology combine with negative perceptions of work and workplace conditions, threatening both retention and service delivery. Key messages • Small medical specialties, like rheumatology, face severe shortage that threaten healthcare for chronically-ill patients and need greater attention. • COVID-19 has reinforced rheumatologists’ workload and stressors, thus worsing mental health and retention.

Plenary 4 Reorienting health services: the transformational potential of health promotion

Abstract Over the past decades, in Europe, the nature of our disease burden has shifted from more communicable and acute to chronic diseases such as cardiovascular diseases, diabetes, cancer and mental ill health. These diseases usually manifest themselves later in life, but they are not necessarily related to biological ageing. They mostly result from an accumulation of unhealthy living patterns since childhood and across the life course. Consumption of processed foods high in fat, salt, and sugar, smoking, excessive alcohol use, too little physical activity and too much stress all contribute to the growing and worsening burden of chronic diseases. These behaviours in turn are shaped by the social, environmental, cultural and economic conditions in which we live, grow, work and age. Once they have developed, chronic diseases can be difficult, or even impossible to cure. Our health services, with a traditional curative approach, are not equipped for this chronic epidemic. There is an urgent need to shift our health services away from the predominant focus on cure and towards prevention, and for policy makers to invest in ensuring healthy living environments and societies. Health promotion and enabling people and population groups to increase control over their health, particularly those facing disadvantage, has the potential to transform our health services, and is critical to ensuring their resilience and sustainability. Despite a growing awareness of the need for change, reorienting structures and systems in practice is challenging, as people can be resistant to change. Siloed approaches within the health sector, but also between social, health, and education sectors continue to prevail, and it is not always easy to find the right levers for change and to build bridges across administrations. This is compounded by a lack of infrastructure, organizational and workforce capacity for health promotion, and sustainable financing mechanisms. Much innovative work is however taking place, which we can learn from and scale up. This plenary session will provide examples of different ways in which health-promoting approaches can reorient health services, strengthen health-promoting and community oriented primary care and prevent chronic diseases. It will highlight what we can learn from behavioural and cultural insights and social prescribing, as well as integrated community initiatives to further support people, across the social gradient, to lead and to maintain healthy lives. It will discuss target setting for further advocacy among policy makers. Speakers: Rüdiger Krech WHO, Geneva, Switzerland Susan Michie University College London, UCL Centre for Behaviour Change, London, UK Jan De Maeseneer European Commission Expert Panel on Effective Ways of Investing in Health and Ghent University, Belgium Jet Bussemaker Council of Public Health & Society, Netherlands, Leiden University Medical Center, Leiden, Netherlands Cristiano Figueiredo USF da Baixa, Central Lisbon Health Centre Cluster, National School of Public Health, NOVA University Lisbon, Portugal

Health workers labor market before and during the Covid-19 pandemic: Health sector capacity of Serbia

Abstract Background During the COVID-19 pandemic surges, healthcare stakeholders were concerned with the sufficiency of available health workforce capacity. In this study we examined the changes in the supply and demand of physicians, nurses and care workers in Serbia over the period 2011-2021. Methods The National Employment Service (NES) data on total number of unemployed physicians, nurses and care workers, and vacancy data in health sector were described using the annualized % change for the period 2011-2021. The long-term duration of unemployed female physicians and nurses was further analyzed. Results In 2021, NES has registered total of 13,332 unemployed physicians, nurses and care workers, out of which the majority were females (79%), and nurses and care workers (88%). 2021 data on vacancies showed that only 16% of unemployed workers were needed. The peak of health workers unemployment was in 2016, highlighting the period of unemployment rise (2011-2016) at an annualized rate of 3.7% for medical doctors’ specialists, 6.4% for medical doctors without specialization, and 3.2% for nurses and care workers, and the period of unemployment decline (2017-2021) at an annualized rate of -7.9% for medical doctors’ specialists, -10.9% for medical doctors without specialization, and -5.9% for nurses and care workers. The annualized rate of decline was the lowest for female nurses and care workers. On average 53% of all long term unemployed medical doctors, nurses and care workers were women. In comparison to 2019, during the COVID-19 epidemic in 2020 and 2021 the number of vacancies for specialists and nurses and care workers has increased by one-third. Conclusions The study indicated a continuous mismatch between the supply and demand of physicians and nurses in Serbia (a surplus of some categories of nurse-specialists versus a shortage of some doctor specialists). The Serbian stakeholders need to urgently intervene regarding the long-term unemployment of female health workers. Key messages • NES data imply a low capacity of the Serbian health sector to absorb the huge numbers of (long-term) unemployed health workers. • It is necessary to thoroughly examine and counteract the causes of the dramatic number of unemployed health workers on the NES records in Serbia.

Implementing leading practices in regional-level primary care workforce planning: Lessons learned in Toronto.

Investment in capacity for implementation of leading practices in regional-level health workforce planning is essential to support equitable distribution of resources and deployment of a health workforce that can meet local needs. Ontario Health Toronto and the Canadian Health Workforce Network (CHWN) co-developed and operationalized an integrated workforce planning process to support evidence-based primary care workforce decision-making for the Toronto region. The resultant planning toolkit incorporates planning processes centred around engagement with stakeholders, including environmental scanning tools and a quantitative planning model. The outputs of the planning process include estimates of population need and workforce capacity and address challenges specific to Toronto, such as patient mobility, anticipated rapid population growth, and physician retirement. We highlight important challenges and key considerations in the development and operationalization of workforce planning processes, particularly at the regional level.

Health services supervision in a protracted crisis: a qualitative study into supportive supervision practices in South Sudan

BackgroundThe health system in South Sudan faces extreme domestic resource constraints, low capacity, and protracted humanitarian crises. Supportive supervision is believed to improve the quality of health care and service delivery by compensating for flaws in health workforce management. This study aimed to explore the current supervision practices in South Sudan and identify areas for quality improvement.MethodsThe study employed qualitative approaches to collect and analyse data from six purposefully selected counties. Data were collected from 194 participants using semi-structured interviews (43 health managers) and focus group discussions (151 health workers). Thematic content analysis was used to yield an in-depth understanding of the supervision practices in the health sector.ResultsThe study found that integrated supportive supervision and monitoring visits were the main approaches used for health services supervision in South Sudan. Supportive supervision focused more on health system administration and less on clinical matters. Although fragmented, supportive supervision was carried out quarterly, while monitoring visits were either conducted monthly or ad hoc. Prioritization for supportive supervision was mainly data driven. Paper-based checklists were the most commonly used supervision tools. Many supervisors had no formal training on supportive supervision and only learned on the job. The health workers received on-site verbal feedback and, most times, on-the-job training sessions through coaching and mentorship. Action plans developed during supervision were inadequately followed up due to insufficient funding. Insecurity, poor road networks, lack of competent health managers, poor coordination, and lack of adequate means of transport were some of the challenges experienced during supervision. The presumed outcomes of supportive supervision were improvements in human resource management, drug management, health data reporting, teamwork, and staff respect for one another.ConclusionSupportive supervision remains a daunting task in the South Sudan health sector due to a combination of external and health system factors. Our study findings suggest that strengthening the processes and providing inputs for supervision should be prioritized if quality improvement is to be attained. This necessitates stronger stewardship from the Ministry of Health, integration of different supervision practices, investment in the capacity of the health workforce, and health infrastructure development.

Design and Evaluation of the Veterinary Epidemiology Teaching Skills (VETS) Workshop: Building Capacity in the Asia-Pacific Region.

Building workforce capacity in epidemiology skills for veterinarians in the Asia-Pacific region is crucial to health security. However, successful implementation of these programs requires a supply of trained veterinary epidemiology teachers and mentors. We sought to design and evaluate delivery of a 4-day Veterinary Epidemiology Teaching Skills (VETS) workshop as part of a larger project to strengthen field veterinary epidemiology capacity. Thirty-five veterinarians were selected to participate in the 4-day VETS workshop, consisting of nine modules delivered synchronously online. Participants were formatively assessed and given feedback from peers and facilitators on all activities. Data were collected with pre- and post-course questionnaires. Numeric values were categorized to convert into an ordinal scale with four categories. Qualitative data were analyzed using thematic analysis. Thirty-four veterinary epidemiologists from eight countries of the Asia-Pacific completed the workshop. Participants felt able to achieve most key learning outcomes through provision of succinct literature, teaching frameworks, and active participation in small groups, with multiple opportunities to give and receive feedback. Although the online workshop provided flexibility, participants felt the addition of face-to-face sessions would enrich their experience. Additionally, protected time from work duties would have improved their ability to fully engage in the workshop. The VETS workshop granted an effective online framework for veterinary epidemiologists to develop and practice skills in teaching, facilitation, assessment, feedback, case-based learning, program evaluation, and mentorship. A challenge will be ensuring provision of local teaching and mentoring opportunities to reinforce learning outcomes and build workforce capacity.

Rethinking digital construction: a study of BIM uptake capability in BIM infant construction industries

PurposePractitioners have reported a minimal and non-use of building information modelling (BIM), especially in small and medium-sized organisations and BIM infant construction industries. This development calls for a reappraisal of organisations’ strength in capabilities required for BIM uptake towards the target of global construction digitalisation. This study aims to assess the BIM Level 2 uptake capability of organisations in a BIM infant construction industry and identify the underlying interactions between the capability criteria.Design/methodology/approachThe study used a multivariable analysis of fifteen descriptors identified from the people, process, policy, finance and technology domain. Data collection was done in the BIM infant construction industry in Nigeria. Verification of the descriptors and an evaluation of BIM uptake capability in organisations was done. Seventy-three responses were received within the selected context, and data analysis was done with mean weighting and exploratory factor analysis. Maximum Likelihood extraction and Direct Oblimin rotation were used.FindingsFactor analysis revealed three factors that explained 53.28% of the total variance in the BIM Level 2 uptake capability of construction organisations. The factors are workforce capacity and continuous development, an affinity for innovation and strength in physical and operational facilities.Research limitations/implicationsThis study provides an overarching and insightful discussion on BIM uptake capability and construction digitalisation with evidence from a BIM-infant construction industry.Practical implicationsThe findings of this study are a piece of valuable empirical evidence on Level 2 BIM uptake capability. This empirical situation analysis will inform the advocacy for the advancement of BIM and enhanced utilisation of building information. Evidence on the capability performance of the BIM infant industry has been revealed.Originality/valueThe outcome is expected to stir debate on the preparedness of organisations to further exploit the benefits of BIM in the BIM infant construction industry. Examination of the capability for a particular phase of BIM is scanty in the literature.

Commentary: Investing in advance practice nurses is a global health system solution.

Investment and full utilization of advance practice nurses to maximize universal health coverage, optimize access to primary health care, and for building health workforce capacity and professional leadership is direly warranted globally. Funding advance practice nurse education programs, leadership opportunities, service delivery systems, and rewarding jobs regionally and nationally is a viable value-added solution for our communities, countries, and the nursing profession.

Building health workforce capacity in Northern Australia

The Menzies Ramaciotti Regional and Remote Health Sciences Training Centre (Menzies-Ramaciotti Centre) is located within the Menzies School of Health Research (Menzies) in Darwin, Northern Territory (NT). The Menzies-Ramaciotti Centre is contributing to the development of a local health workforce in the NT, including a strong biomedical workforce. The Centre facilitates health workforce career progression for regional and remote youth, with a focus on career development for Aboriginal and Torres Strait Islander (First Nations) youth. The Centre works in collaboration with a range of industry and education partners, who also have strong workforce development goals and a commitment to serving a vital community need to build pathways into work and study with First Nations peoples. Part of the Centre’s focus entails delivery of high-quality training in biomedical sciences, including theoretical and practical skill development in microbiology, laboratory techniques, immunology, public health, data science, allied health, and health research. The Centre uses a non-linear, strengths-based approach to training with a multiplicity of entry and exit points including high school work experience placements, traineeships, vocational placements, as well as undergraduate and postgraduate placements.

Understanding the application of genomics knowledge in nursing and midwifery practice: A scoping study

BackgroundWith the increased realisation of the benefits of genomic testing, nurses and midwives are being exposed to genomic care as a part of normal clinical practice. AimTo explore how Queensland nurses and midwives are applying genomics knowledge in clinical practice to understand how best to support the workforce to meet patient needs in response to increased genomic testing rates. MethodsA scoping methodology was used whereby the research question was defined, relevant studies were identified for the purposes of a literature review, followed by interviews with 32 nurses and midwives to support the interpretation of the literature review and to understand the implications for practice. FindingsNurses and midwives are working in partnership with their patients and families to support genomic decision making. The emerging needs of patients to understand their diagnostic and treatment pathway is forcing nurses and midwives to self-educate to keep pace with current practice demands. This approach to upskilling is not adequate for those nurses and midwives currently who are regularly exposed to patients requiring genomic support. DiscussionDespite national and local policy documents identifying genomics workforce capacity as a strategic priority action and clinicians reporting their involvement in genomics care, there is a lack of succession planning, organisational support and educational opportunities to support these advances in practice. ConclusionThere is a need to address the emerging genomic workforce and education requirements to ensure nurses and midwives are capable of supporting patients undergoing genomic testing.

Opportunities for Occupational Therapy Practitioners to Collaborate in Shaping Mental Health Policy and Practice to Support the 988 Initiative

In June of 2021, the American Occupational Therapy Association (AOTA) joined on as a signatory to the Unified Vision for Transforming Mental Health and Substance Use in America developed by Chief Executive Officers at 14 mental health advocacy, direct services and professional organizations. As one of the 44 allied signatory organizations, AOTA staff joined sessions to discuss the $8 billion in new federal stimulus funds for mental health care through 988. The bill provides funding for states to develop a three-digit telecommunication code to support those in a mental health or emotional crisis. Once learning details about the 988 Suicide and Crisis Lifeline and bill to provide funding, the AOTA Workforce Capacity Building team enlisted the expertise, talents, and resources of members to strategize on upcoming opportunities to help fill the workforce gap of mental health professionals and align views to position the future of the profession in mental and behavioral health. A micro volunteer group emerged consisting of those in academia, practice, and AOTA staff members. In support of the Unified Visionary Signatory, the AOTA encourages occupational therapy practitioners to use their skills, training, and expertise to address mental health in our communities: Every person. Every age. Every condition. This document highlights the challenges and opportunities for the profession of occupational therapy in support of the 988 Suicide and Crisis Lifeline bill and resources developed to educate the occupational therapy community. The objective was to assist in mobilizing those in the profession to help fill workforce gaps in mental health.

Evaluation of research capacity and culture of hospital pharmacists and pharmacy technicians in a state-wide Australian public health service: A cross-sectional survey.

Integrating research with clinical practice is essential for evidence-based practice and continuous improvement in health care. Little is known about the research capacity and culture of the Australian hospital pharmacy workforce, particularly in rural areas and for pharmacy assistants/technicians. This paper aims to characterise the research capacity and culture of a state-wide public-hospital pharmacy service at organisation, team and individual levels, and to explore variables which influence research confidence and success. An online, anonymous, cross-sectional survey using the validated Research Capacity in Context tool was emailed to all pharmacists, pharmacy assistants/technicians and non-clinical staff employed by a statewide pharmacy service in South Australia. Respondent characteristics and organisation, team and individual scores of research skill/success were summarised using descriptive statistics. T-tests compared results for pharmacists and pharmacy assistants/technicians and metropolitan-based and non-metropolitan-based staff. Regression analyses explored predictors of pharmacists individual research skill/success scores. A response rate of 43.4% (n=278/641, 19 sites) was obtained. Respondents were primarily pharmacists (68%) and pharmacy assistants/technicians (28%); 91% were practicing in a metropolitan setting. 47% reported no research experience. Highest scores for research skill/success were observed at the organisational level (mean score 6.0/10) vs. team (mean score 5.6/10) and individual levels (mean score 5.1/10). Within each level specific items that scored poorly were identified. Individual research skills/success scores were higher in pharmacists vs. pharmacy assistants/technicians (mean score 5.2/10 vs. 4.2/10, p<0.01), and were not different between staff in metropolitan vs. non-metropolitan settings (mean scores 5.2 vs. 5.0, p=0.77). For pharmacists, undertaking undergraduate or internship research projects or postgraduate research training were associated with higher individual scores of research skills and success. This research extends understanding of hospital pharmacy research capacity and culture, describes research skills and success in hospital pharmacy technicians/assistants for the first time and highlights low-scoring areas; these could be targeted to improve research capacity and culture at an individual, team and organisational levels.

A national analysis of the pharmacy workforce in Indonesia

BackgroundPharmacists play a fundamental role in healthcare systems and achieving Universal Health Coverage (UHC) through quality primary healthcare service provision. While the World Health Organization (WHO) forecasts a global shortage of health workforce by 2030, mainly affecting low- and middle-income nations (LMICs), limited published literature is found regarding pharmacy workforce capacity in LMICs, including Indonesia. This paper aims to analyse pharmacists’ capacity in Indonesia to identify emerging workforce planning gaps for future workforce planning and policies in Indonesia.MethodSeveral data sources were accessed, including a database from the National Pharmacy Committee and the professional leadership body in Indonesia. Descriptive (frequencies, percentages, and mean), correlational and time-series analysis using curve estimation were conducted. Secondary data on the number of programmes, pharmacy students, pharmacy workforce (pharmacists and pharmacy technicians) per province were obtained from the Ministry websites and reports.ResultThere were a total of 77 191 registered pharmacists in Indonesia in 2019. The pharmacists’ pyramid showed a youth bulge as a general indication of market expansion in the education sector correlating to the pharmacy programme’s number and size. There was a variation in pharmacy workforce density and access to pharmacy programmes across islands, which also were strongly correlated. Forecasting estimates that by 2030, women will represent around 86% of pharmacists in Indonesia. More female pharmacists were found working in the hospital and primary healthcare (providing direct services to patients) than male pharmacists. Younger pharmacists worked in the industrial sector, while older pharmacists worked in governmental and educational institutions.ConclusionThis study signposted workforce planning gaps for policy development in Indonesia, including a need to develop structured training to support early career pharmacists in their practice. There is also a need for better access to professional development programmes designed to support female pharmacists return to the regulated workforce following career breaks. National policy to promote equitable distribution and retention of pharmacists is recommended.

Identifying the Leverage Points in the Household Solid Waste Management System for Harare, Zimbabwe, Using Network Analysis Techniques

Managing household solid waste (HSW) has gone beyond what the Harare local government can handle. Inadequate knowledge of the interactions existing between issues that affect the efficient running of waste management systems is one of the major hindrances in waste management planning in developing countries like Zimbabwe. The complexity of the waste management system for a given municipal area needs to be identified and understood to generate appropriate and efficient waste management strategies. Network analysis (NA) is a methodology extensively used in research to help reveal a comprehensive picture of the relationships and factors related to a particular phenomenon. The methodology reduces the intricacy of large systems such as waste management to smaller and more understandable structures. In this study, NA, which was done mainly using the R software environment, showed a result of 1.5% for network density, thus signifying that for Harare, waste management strategies need to be ‘seeded’ in various parts of the system. The Pareto principle and the 3Rs (Reduce, Reuse, Recycle) concept were applied to suggest the issues to prioritize and generate strategies that could potentially affect significant change to the city’s waste management system. The key issues identified, in their order of importance, are an increase in uncollected waste, low waste collection efficiency, increase in illegal waste dumping, the deteriorating country’s economy, reduced municipal financial capacity, reduced municipal workforce capacity, inadequate or unreliable waste data, increase in waste volume, increase in the number of street vendors, no waste planning and monitoring unit, no engineered landfills in the city, increase in waste collection pressure, low waste collection frequency, increase in the unemployment rate, reduced municipal technical capacity, few waste collection vehicles, limited vehicles maintenance, distinct socio-economic classes, high vehicles breakdown, and increase in population.

Describing the Rehabilitation Workforce Capacity in the Public Sector of Three Rural Provinces in South Africa: A Cross-Sectional Study.

The World Health Organisation emphasises the importance of addressing gaps in health systems where rehabilitation services are poorly integrated. In South Africa, regions with the largest disability rates are usually the areas where rehabilitation is least accessible, due to inadequate workforce capacity. The first step towards addressing workforce capacity is to determine current capacity. This paper presents a cross-sectional study to describe rehabilitation workforce data in the public sector of three rural South African provinces. A web-based therapist survey and a telephonic facility survey was conducted. Data were collected regarding total number of therapists per province, age, years employed, qualifications, salary level, profession type, level of care, and rural/urban distribution. Descriptive statistics were conducted, while Chi-squared tests compared professions regarding highest qualification and salary level. Population-adjusted ratios were calculated using national uninsured population statistics. The web-based survey had 639 responses while the telephonic survey reported on 1166 therapists. Results indicated that the mean age of therapists across the respective provinces was 28, 35 and 31 years of age, and the mean employment years in the respective provinces were three, eight and five years. Most of the workforce (n = 574) had a bachelor’s degree as their highest qualification. A total of 27% of the workforce were community service therapists and 61% of therapists earned a production-level salary. Occupational therapy was best (40%) and speech and audiology therapy least (7%) represented. Three percent of therapists worked at primary level, versus eighty percent at secondary level. Forty percent of therapists worked in rural areas. Workforce density per province ranged from 0.71–0.98 per 10,000 population. Overall, results show that the rehabilitation workforce density is low, and that the distribution of therapists between rural and urban settings, and levels of care, is inequitable. Considering the rise in rehabilitation need, prioritisation and strengthening of the rehabilitation workforce capacity is vital to ensure integration across all levels of care and service.

Emotional Exhaustion Among US Health Care Workers Before and During the COVID-19 Pandemic, 2019-2021

Extraordinary strain from COVID-19 has negatively impacted health care worker (HCW) well-being. To determine whether HCW emotional exhaustion has increased during the pandemic, for which roles, and at what point. This survey study was conducted in 3 waves, with an electronic survey administered in September 2019, September 2020, and September 2021 through January 2022. Participants included hospital-based HCWs in clinical and nonclinical (eg, administrative support) roles at 76 community hospitals within 2 large health care systems in the US. Safety, Communication, Organizational Reliability, Physician, and Employee Burnout and Engagement (SCORE) survey domains of emotional exhaustion and emotional exhaustion climate. The percentage of respondents reporting emotional exhaustion (%EE) in themselves and a climate of emotional exhaustion (%EEclim) in their colleagues. Survey items were answered on a 5-point scale from 1 (strongly disagree) to 5 (strongly agree); neutral or higher scores were counted as "percent concerning" for exhaustion. Electronic surveys were returned by 37 187 (of 49 936) HCWs in 2019, 38 460 (of 45 268) in 2020, and 31 475 (of 41 224) in 2021 to 2022 for overall response rates of 74.5%, 85.0%, and 76.4%, respectively. The overall sample comprised 107 122 completed surveys. Nursing was the most frequently reported role (n = 43 918 [40.9%]). A total of 17 786 respondents (16.9%) reported less than 1 year at their facility, 59 226 (56.2%) reported 1 to 10 years, and 28 337 (26.9%) reported 11 years or more. From September 2019 to September 2021 through January 2022, overall %EE increased from 31.8% (95% CI, 30.0%-33.7%) to 40.4% (95% CI, 38.1%-42.8%), with a proportional increase in %EE of 26.9% (95% CI, 22.2%-31.8%). Physicians had a decrease in %EE from 31.8% (95% CI, 29.3%-34.5%) in 2019 to 28.3% (95% CI, 25.9%-31.0%) in 2020 but an increase during the second year of the pandemic to 37.8% (95% CI, 34.7%-41.3%). Nurses had an increase in %EE during the pandemic's first year, from 40.6% (95% CI, 38.4%-42.9%) in 2019 to 46.5% (95% CI, 44.0%-49.1%) in 2020 and increasing again during the second year of the pandemic to 49.2% (95% CI, 46.5%-51.9%). All other roles showed a similar pattern to nurses but at lower levels. Intraclass correlation coefficients revealed clustering of exhaustion within work settings across the 3 years, with coefficients of 0.15 to 0.17 for emotional exhaustion and 0.22 to 0.24 for emotional exhaustion climate, higher than the .10 coefficient typical of organizational climate (a medium effect for shared variance), suggestive of a social contagion effect of HCW exhaustion. This large-scale survey study of HCWs spanning 3 years offers substantial evidence that emotional exhaustion trajectories varied by role but have increased overall and among most HCW roles since the onset of the pandemic. These results suggest that current HCW well-being resources and programs may be inadequate and even more difficult to use owing to lower workforce capacity and motivation to initiate and complete well-being interventions.

Rehabilitation workforce descriptors: a scoping review

BackgroundA comprehensive, accurate description of workforce capacity is important for health service planning, to ensure that health services meet local needs. In many low- to middle-income countries, the government’s service planning ability is barred by the lack of accurate and/or comprehensively-described workforce data. In these low-resource settings, lack of appropriate planning leads to limited or no access to rehabilitation services. Variability in the definitions and scope of rehabilitation professionals further complicates the understanding of rehabilitation services and how it should be planned and delivered. Another challenge to describing the primary rehabilitation workforce capacity, is the lack of standardised and agreed-upon global metrics. These inconsistencies highlight the need for a comprehensive understanding of current practices, which can offer guidance to countries wishing to describe their rehabilitation workforce. This study aimed to scope the range of descriptors and metrics used to describe the rehabilitation workforce and to compare the workforce across countries that used similar descriptors in published reports.MethodsA scoping review was conducted according to the five-step framework first developed by Arksey and O’Malley. The review included a broad search of literature regarding the rehabilitation workforce and how countries quantify and describe the rehabilitation workforce.ResultsNineteen studies on rehabilitation workforce capacity were identified. All but one (a cross-sectional study) were database reviews. The main descriptors and indicators used to describe the rehabilitation workforce capacity were profession type, age, gender, distributions between urban/rural, level of care, and private/public sectors, absolute count totals, and population-adjusted ratios.ConclusionThis scoping review provided an overview of descriptors and indicators used to describe the rehabilitation workforce capacity internationally. The study is a first step towards developing standardised descriptors and metrics to quantify the rehabilitation workforce capacity, that will allow for comparison between different settings.Trial registrationThis scoping review protocol has been registered with the Open Science Framework (http://osf.10/7h6xz).

Master of Public Health Education in the United States Today: Building Leaders of the Future.

For decades, there have been calls to action to change the status quo of public health education in the United States to respond to workforce needs and help reinforce capacity. During the last 10 years, schools and programs of public health have planned and implemented programmatic and curricular changes. This study explored the focus of master of public health (MPH) education in the United States today. We used a 3-phase mixed-methods study to compile data to describe the current state and focus of MPH education in the United States via survey data collection (November-December 2019), semistructured interviews (January-February 2020), and document reviews. Survey responses represented at least 43% (93/215) of eligible MPH programs in the United States. Most respondents (86%, 99/115) reported that the primary focus of MPH education in the United States is to prepare graduates for public health practice and employment linked to public health, and 54% (59/109) reported that their MPH programs adopted this focus in the last 5 years. MPH programs invested in student learning, competence development, and supporting workforce readiness, including a focus on leadership abilities. Programs noted that they seek to develop strategic thinkers and engaged leaders with abilities to understand and address emergent public health needs. Public health education in the United States is in a period of change. MPH programs reported responding to workforce needs by closing gaps in workforce capacity and developing compassionate and professional leaders who can understand needs, collaborating with communities, and facilitating action that will ameliorate health disparities and promote social injustice by practicing public health in new ways.

ATTITUDES, WORK ROLES AND BARRIERS TO NUTRITION CARE - INTERVIEWS WITH AUSTRALIAN AND UK-BASED MEDICAL DOCTORS.

Poor diet is implicated in multiple chronic diseases. Although doctors may be well placed to facilitate nutrition care, nutrition remains a low priority in medical education internationally. Consensus is required on nutrition competencies as a benchmark for education with a regulatory framework to ensure implementation. The aim of this qualitative study was to explore work roles, attitudes, barriers and enablers in the delivery of nutrition care among a cohort of Australian and UK doctors. Semi-structured interviews were conducted with primary care doctors/general practitioners (n = 14) and medical specialists (n = 8) based in Australia and the United Kingdom to explore work roles, attitudes, barriers and enablers in the delivery of nutrition care. Framework analysis identified five key themes: (1) knowledge and skills in nutrition to support medical nutrition care, (2) the delivery of nutrition education, (3) multidisciplinary and interdisciplinary care, (4) systemic barriers and facilitators to care and (5) the need for a paradigm shift. Participants acknowledged nutrition as an important component of medical care but recognised they are currently ill-equipped to support such care, identifying limitations to the systems supporting integrated care. Participants identified that nutrition sits within both a health promotion and medical/treatment model, but they currently work only within the latter. Participants highlighted a lack of knowledge and training regarding nutrition, without which change is not possible. Efforts to improve the nutrition capacity of the medical workforce must be matched by increased investments in primary prevention, including nutrition - a paradigm shift from the medical model.