Workforce Initiatives Research Articles

341 GEDI WISE: Association Between Abnormal Geriatric Assessments in the Emergency Department and Subsequent Hospitalization

The Geriatric Emergency Department Innovations through Workforce, Informatics and Structural Enhancements (GEDI WISE) initiative utilizes specially trained nurse liaisons to perform a series of validated tests on emergency department (ED) geriatric patients in order to identify geriatric specific needs and provide care coordination. The objective of this study is to evaluate the ability of these geriatric assessments to predict hospitalization in geriatric patients with normal vital signs as a marker of possible “social admissions.” This was a prospective observational study of geriatric ED patients from April 2013 to March 2015. Geriatric patients in this study were evaluated by a geriatric nurse liaison (GNL) and had geriatric-specific assessments performed and recorded in the electronic medical record (EMR) including: Identification of Seniors at Risk (ISAR) Short Portable Mental Status Questionnaire (SPMSQ), Katz Activities of Daily Living (Katz ADL), Beers Criteria, Timed Up and Go test (TUG), and Confusion Assessment Method (CAM). All patients age 65+ with normal vital signs, who were evaluated by the GNL were included in this study. Demographics and vital sign variables were categorized as normal and abnormal according to previously reported ED literature, and geriatric assessments results were dichotomized. The primary outcome was hospitalization, including inpatient and observation status. Bivariate analysis was performed between geriatric assessment results and the hospitalization outcome. To adjust for demographics and emergency severity index (ESI), logistic regression was then performed for each of the assessments. There were 48,229 geriatric ED patients during the study period, 2,559 received GNL evaluation. The abnormal results of completed assessments are as follows: ISAR 1776/2559 (69%), SPMSQ 496/2,294 (22%), Katz ADLs 1,016/2,089 (49%), Beers 789/1339 (59%), TUG 732/778 (94%) CAM 44/126 (35%). For patients with normal vital signs, the unadjusted odds ratios showed significantly increased odds of hospitalization for all geriatric assessments. After adjusting for age, race, and ESI, only ISAR and Katz ADLs were significantly associated with increased odds of hospitalization (Table). In geriatric ED patients with normal vital signs, most geriatric assessments do a poor job of predicting hospitalization after adjusting for ESI and demographics. This may be because GNLs are able to effectively address the issues they identify through these assessments to prevent “social admisions.” Patients with difficulty performing their ADLs may represent a group for which it is more difficult to effectively coordinate care in the ED. Despite previous literature showing the poor performance of ISAR, in this sample it is associated with increased odds of hospitalization, and may have merit as a screening test for patients at high risk for hospitalization.TableOdds ratio for hospitalizationAbnormal geriatric AssessmentUnadjusted Odds Ratio (95% CI)Adjusted Odds Ratio (95% CI)*ISAR2.87 (2.26-3.65)2.44 (1.89-3.15)SPMSQ1.20 (1.03-1.41)1.15 (0.97-1.36)CAM5.52 (1.09-28.00)4.19 (0.71-24.57)Katz ADL1.66 (1.29-2.11)1.58 (1.22-2.04)TUG test2.12 (1.05-4.29)2.07 (0.97-4.42)Beers criteria1.45 (1.08-1.97)1.29 (0.94-1.77)*Odds ratio adjusted for age, race and Emergency Severity Index (ESI). Open table in a new tab

Russian-speaking children and material needs in the reformist context: an ecological study of curriculum development

Abstract This study examines the process for gaining Russian instructional materials at a dual language immersion program for school children in the Western USA. The ethnographic approach to the bilingual and multilingual setting draws on Urie Bronfenbrenner’s ecological systems theory to explore how the context impedes or supports the instructional need for appropriate language materials in the reformist period: a period marked by standardized testing and managed schools under a business model. This transdisciplinary approach crossing linguistic, anthropological, and psychological fields was selected to explore the cultural–historical implications in the USA where bilingual education was aggressively dismantled with the onset of the World Wars. The findings demonstrate organizational leadership that was resistant to the needs of the Russian teachers and families, and is lacking in knowledge of languages, translation, and pedagogy. Findings also show how a community worked together for the benefit of young learners. Implications include the need for the US Government to better support immigrant communities and schools to achieve the multilingual workforce initiative. A protocol for selecting instructional materials from abroad is provided to assist with curriculum development.

The BHEF National Higher Education and Workforce Initiative

Partnerships between higher education and business have long been an important part of the academic landscape, but often they are based on shorter-term transactional objectives rather than on longer-term strategic goals. BHEF's National Higher Education and Workforce Initiative brings together business and academia at the institutional, regional and national levels to create sustainable new opportunities for undergraduates to learn about emerging fields such as data science and analytics, cybersecurity, energy, risk management, and social and mobile technologies through direct engagement with the companies working in these areas. These partnerships are built on a base of evidence, strategic business engagement and design principles that aim to align needs with existing and enhanced capacity.

Implementation of a workforce initiative to build trauma-informed child welfare practice and services: Findings from the Massachusetts Child Trauma Project

Children involved with Child Protective Services experience high rates of chronic and cumulative interpersonal trauma and adversity, referred to as complex trauma, that can have a profoundly negative impact on well being across the life course. Child welfare agencies face myriad challenges in addressing the needs of children with complex trauma. In response, the Massachusetts Child Trauma Project (MCTP) was launched as a statewide initiative to enhance the capacity of child welfare workers and child mental health providers to identify, respond, and intervene early and effectively with children traumatized by chronic loss, abuse, neglect, and violence. Specifically, this large-scale multi-system improvement effort is driving practice change through three key mechanisms in all regions of the state: (1) training child welfare staff and resource parents to recognize and respond to child trauma, (2) disseminating three trauma-focused EBTs in community-based mental health agencies via sequential cohorts of intensive Learning Collaboratives, and (3) implementing child welfare-led Trauma-Informed Leadership Teams (TILTs) that bring mental health providers, child welfare workers, and consumers together to sustain efforts to implement, maintain and spread trauma-informed practices. The article describes the development and implementation of this multiyear initiative and a number of key lessons learned to date.

Principles to guide sustainable implementation of extended-scope-of-practice physiotherapy workforce redesign initiatives in Australia: stakeholder perspectives, barriers, supports, and incentives.

Sustainable implementation of new workforce redesign initiatives requires strategies that minimize barriers and optimize supports. Such strategies could be provided by a set of guiding principles. A broad understanding of the concerns of all the key stakeholder groups is required before effective strategies and initiatives are developed. Many new workforce redesign initiatives are not underpinned by prior planning, and this threatens their uptake and sustainability. This study reports on a cross-sectional qualitative study that sought the perspectives of representatives of key stakeholders in a new workforce redesign initiative (extended-scope-of-practice physiotherapy) in one Australian tertiary hospital. The key stakeholder groups were those that had been involved in some way in the development, management, training, funding, and/or delivery of the initiative. Data were collected using semistructured questions, answered individually by interview or in writing. Responses were themed collaboratively, using descriptive analysis. Key identified themes comprised: the importance of service marketing; proactively addressing barriers; using readily understood nomenclature; demonstrating service quality and safety, monitoring adverse events, measuring health and cost outcomes; legislative issues; registration; promoting viable career pathways; developing, accrediting, and delivering a curriculum supporting physiotherapists to work outside of the usual scope; and progression from “a good idea” to established service. Health care facilities planning to implement new workforce initiatives that extend scope of usual practice should consider these issues before instigating workforce/model of care changes.

Introduction: The Need for Gender-Targeted Workforce Development Initiatives

The United States entered one of its deepest recessions in the late 2000s—workers faced jobs that were not coming back, long-term unemployment, and increased economic insecurity. These severe problems emphasize the need for government workforce initiatives. Yet investments in comprehensive employment and training policies have declined in real terms by nearly 70 percent since 1979. This article discusses this evolution, with a focus on the persistence of gender segmentation that workforce training initiatives seem to reinforce. Finally, it concludes with a discussion of the four articles that complete this special issue.

Sustaining supply of senior academic leadership skills in a shortage environment: a short review of a decade of dental experience

For the past decade, and expected for the next decade, Australia faces a significant health workforce shortage and an acute maldistribution of health workforce. Against this background the governments at both national and state level have been increasing the training places for all health practitioners and trying to redress the imbalance through a strong regional focus on these developments. Dentistry has been an active participant in these workforce initiatives. This study examines the increasing demand for academics and discusses the existing pathways for increase, and also examines in detail the advantages of a sustainable, shared-model approach, using dentistry as a model for other disciplines. Three non-exclusive pathways for reform are considered: importation of academics, delayed retirement and the shared resource approach. Of the various solutions outlined in this review a detailed explanation of a cost-effective shared model of senior academic leadership is highlighted as a viable, sustainable model for ameliorating the shortage.

Shortage of Doctors, Shortage of Data: A Review of the Global Surgery, Obstetrics, and Anesthesia Workforce Literature

The global surgery workforce is in crisis in many low- and middle-income countries (LMICs). The shortage of surgery, obstetrics, and anesthesia providers is an important cause of the unmet need for surgical care in LMICs. The goal of this paper is to summarize the available literature about surgical physicians in LMICs and to describe ongoing initiatives to supplement the existing surgical workforce data. We performed a systematic search and literature review of the English-language literature regarding the number of surgeons, obstetrician-gynecologists, and anesthesiologists practicing in LMICs. Literature describing the number of surgeons, obstetricians, and anesthesiologists practicing in LMICs represents a small minority of LMICs, and indicates consistently low levels of surgical physicians. Our literature search yielded comprehensive data for only six countries. No national data were found for 23 of the 57 countries considered by the World Health Organization (WHO) to be in health workforce 'crisis.' Across LMICs, general surgeon density ranged from 0.13 to 1.57 per 100,000 population, obstetrician density ranged from 0.042 to 12.5 per 100,000, and anesthesiologist density ranged from 0 to 4.9 per 100,000. Total anesthesiologist, obstetrician, and surgeon density was significantly correlated with gross domestic product (GDP) per capita (r (2) = 0.097, p = 0.0002). The global surgery workforce is in crisis, yet is poorly characterized by the current English-language literature. There is a critical need for systematically collected, national-level data regarding surgery providers in LMICs to guide improvements in surgery access and care. The Harvard Global Surgery Workforce Initiative and the WHO global surgical workforce database are working to address this need by surveying Ministries of Health and surgical professional organizations around the world.

Commentaries on health services research

Commentaries on health services research

Tracking the workforce: the American Society of Clinical Oncology workforce information system.

In anticipation of oncologist workforce shortages projected as part of a 2007 study, the American Society of Clinical Oncology (ASCO) worked with a contractor to create a workforce information system (WIS) to assemble the latest available data on oncologist supply and cancer incidence and prevalence. ASCO plans to publish findings annually, reporting on new data and tracking trends over time. THE WIS REPORT IS COMPOSED OF THREE SECTIONS: supply, new entrants, and cancer incidence and prevalence. Tabulations of the number of oncologists in the United States are derived mainly from the American Medical Association Physician Masterfile. Information on fellows and residents in the oncology workforce pipeline come from published sources such as Journal of the American Medical Association. Incidence and prevalence estimates are published by the American Cancer Society and National Cancer Institute. The WIS reports a total of 13,084 oncologists working in the United States in 2011. Oncologists are defined as those physicians who designate hematology, hematology/oncology, or medical oncology as their specialty. The WIS compares the characteristics of these oncologists with those of all physicians and tracks emerging trends in the physician training pipeline. Observing characteristics of the oncologist workforce over time allows ASCO to identify, prioritize, and evaluate its workforce initiatives. Accessible figures and reports generated by the WIS can be used by ASCO and others in the oncology community to advocate for needed health care system and policy changes to help offset future workforce shortages.

Intervening to Enhance Eudaimonic Well-being in the Workplace: The Active Workforce Initiative

Intervening to Enhance Eudaimonic Well-being in the Workplace: The Active Workforce Initiative

A decade of Australian Rural Clinical School graduates - where are they and why?

The Australian Rural Clinical School (RCS) initiative has been addressing the rural medical workforce shortage at the medical education level for over a decade. A major expectation of this initiative is that it will improve rural medical workforce recruitment and subsequent retention through a rurally based undergraduate clinical training experience. The longitudinal nature of these workforce initiatives means that definitive evidence of its impact on the shortage of rural doctors is yet to be provided; however, to date cross-sectional studies are accumulating a measure of efficacy for these initiatives by monitoring early career factors such as internship location choice and speciality choice of RCS graduates. This article reports on a study in one RCS that is monitoring the impact of rural undergraduate clinical training on trends in workforce participation patterns of its graduates as long as 9 years in the workforce. Career location and speciality choice are reported as well as perspectives on early career intentions and the reality of making career and life decisions as a doctor in the medical workforce. A longitudinal mixed methods sequential explanatory design employed a quantitative data collection phase followed by a qualitative phase with the merging of data sources during the interpretation and analysis. In 2007 a database was established that maintained the contact details of all former graduates since 2002. Every 2 years graduates are invited to participate in a survey and provide an update on the influences on their current career intentions/decisions. The qualitative sample was recruited through a survey question asking for interest in participating in an interview. The whole-sample survey results showed that out of a 64% (N = 115) response rate, 40% of respondents were currently working in non-urban locations. The majority (<n = 51, 53%) had been out in the workforce for 5 to 7 years and general practice was the most frequent speciality choice. Out of 29 interviewees, just over half (n = 16, 55%) were currently working in non-urban locations and primarily in general practice. The majority (n = 17, 58%) had been out in the workforce for 5 to 6 years. Overall they perceived that the primary drivers influencing their early career/life decisions were personal/family reasons and speciality training requirements. The study highlighted what is obvious but often overlooked in recruitment strategies for medical students and prevocational doctors: the significance of the inevitable life decisions that frequently take precedence over career intentions. A decade on there is strong endorsement for the positive influence that rural undergraduate clinical training has on promoting rural career intentions. However the fulfilment of these intentions is at risk when competing with concurrent personal/life choices and while based in an urban training environment. Provision of a continuum of postgraduate training opportunities in rural and regional settings that include a rural focus for specialties such as surgery, anaesthetics and obstetrics could: (1) satisfy speciality training requirements; (2) focus life decisions in a rural environment; and (3) keep rural career intentions viable and congruent with other life goals. The overriding message is: the longer the exposure to training in the rural context, the greater the impact on interest in future rural practice and, particularly, the greater the likelihood that important life decisions will also be made in the rural context.

Dual diagnosis capability after an AOD workforce initiative

PurposeDissemination of good practice information to practitioners is one of the great challenges of the substance abuse treatment sector. The authors' understanding of the process by which research is translated is limited, but a whole of workforce approach is considered best practice. This paper aims to examine organisational change as a result of a workforce capacity‐building program over six months.Design/methodology/approachA total of 195 staff (nine service managers, 39 supervisors and 147 clinicians) in 13 alcohol and other drug (AOD) services across Australia participated in mental health screening and brief intervention training using PsyCheck. PsyCheck is designed to detect and address common mental health symptoms among drug treatment clients. The Dual Diagnosis Capability in Addiction Treatment (DDCAT) index was used to measure capacity before and after training.FindingsThere was no significant difference between baseline and follow‐up DDCAT scores; however, the level of PsyCheck implementation indicated improvement in DDCAT scores.Practical implicationsThe results show that where organisations implement the program successfully, capacity improves; where the program is not well implemented, capacity reduces. Successful implementers report a number of common elements: the screening tool was implemented into routine assessment; there was a single onsite “champion” supporting the implementation; and they worked with the staff and persisted with the implementation even where there was initial worker resistance.Originality/valueThis paper provides the opportunity to assess workforce capacity building and the feasibility of utilising the DCCAT to measure co‐occurring mental health and substance use disorders in Australian AOD services.

Pediatric hospital medicine: A strategic planning roundtable to chart the future

Given the growing field of Pediatric Hospital Medicine (PHM) and the need to define strategic direction, the Society of Hospital Medicine, the American Academy of Pediatrics, and the Academic Pediatric Association sponsored a roundtable to discuss the future of the field. Twenty-one leaders were invited plus a facilitator utilizing established health care strategic planning methods. A "vision statement" was developed. Specific initiatives in 4 domains (clinical practice, quality of care, research, and workforce) were identified that would advance PHM with a plan to complete each initiative. Review of the current issues demonstrated gaps between the current state of affairs and the full vision of the potential impact of PHM. Clinical initiatives were to develop an educational plan supporting the PHM Core Competencies and a clinical practice monitoring dashboard template. Quality initiatives included an environmental assessment of PHM participation on key committees, societies, and agencies to ensure appropriate PHM representation. Three QI collaboratives are underway. A Research Leadership Task Force was created and the Pediatric Research in Inpatient Settings (PRIS) network was refocused, defining a strategic framework for PRIS, and developing a funding strategy. Workforce initiatives were to develop a descriptive statement that can be used by any PHM physician, a communications tool describing "value added" of PHM; and a tool to assess career satisfaction among PHM physicians. We believe the Roundtable was successful in describing the current state of PHM and laying a course for the near future.

Recruitment and Retention of Primary Care Physicians at Community Health Centers: A Survey of Massachusetts Physicians

As the backbone of the safety-net system, community health centers (CHCs) provide access to essential services, yet contend with high provider turnover. Using an online survey, primary care physicians (PCPs) at 62 Massachusetts League of Community Health Centers member sites were queried about recruitment and retention factors. Nearly 300 (n=294) PCPs representing 46 CHCs completed the survey. Female physicians, those practicing in the greater Boston area, and those in practice for 10 or more years reported a higher likelihood of remaining in a CHC. Additional factors included: residency preparedness to practice in CHCs; the interview process; and satisfaction with the CHC's mission, patient diversity and current compensation. With the expansion of CHCs, attention must be paid to the PCP workforce. These survey results can inform advocates, leaders, policymakers, and educators regarding workforce initiatives and practice redesign. Once a commitment is made to caring for CHC patients, if this commitment is sustained, retention is good.

Establishing new nursing roles: a case study of the English community matron initiative

To examine the factors affecting the extent to which English policy on the introduction of community matrons for people with chronic conditions was implemented. Improving health services for people with chronic diseases (long-term conditions) is an international priority. In England, the new post of community matron, a case management role, was introduced. A target was set for 3000 community matrons to be in post by 2008, but this was not achieved. A realist, pragmatic evaluation of the introduction of community matron posts. The study used mixed methods at multiple levels: an analysis of national and local strategy and planning documents, a national survey and a stakeholder analysis using semi-structured interviews in three primary care organisation case study sites. National policy established targets for the introduction of community matron posts, but there was local variation in implementation. Pragmatic decisions reflected the history of local service configurations, available finance, opportunities or challenges created by other service redesigns and scepticism about the value of the community matron role. There was resistance to 'bolt on' nursing roles in primary care. The implementation of the community matron role is an example of how a policy imperative that valued the clinical skills and expertise of nurses was reinterpreted to fit with local patterns of service delivery. Before new nursing roles are introduced through national policies, a more nuanced understanding is required of the local factors that resist or support such changes. There is a need for consultation and understanding of local conditions before the implementation of workforce initiatives. For clinicians, it is important to understand how the context of care shapes priorities and definitions of new nursing roles and how their expertise is recognised and used.

Longitudinal integrated clerkships: transforming medical education worldwide?

In the 60 years following the Flexner Report of 1910, little changed in undergraduate clinical education until the model of a longitudinal integrated clerkship (LIC) evolved as an alternative to specialty-based block rotations. The first LIC, the Rural Physician Associate Program (RPAP) was introduced by the University of Minnesota in 1971 as a rural workforce initiative. Despite the success of the RPAP, it took 20 years for other institutions to develop the next generation of LICs in the 1990s. These initiatives have been shown to be successful in terms of recruitment into primary care and rural practice. The reliance of LICs on educational continuity appears to provide many advantages. Research over the last decade has shown the potential educational advantages of LICs undertaken in both rural and urban clinical settings. Compared with students who undertake teaching hospital clerkship blocks, students who complete some LICs have improved academic results, enhanced patient-centredness, greater exposure to common conditions and more meaningful learning relationships with patients and academic mentors. In this edition of Medical Education, two papers report other potential benefits for student feedback and for general practitioners as educators.

Update on ASCO's Workforce Initiative and Strategic Plan

(2010). Update on ASCO's Workforce Initiative and Strategic Plan. Oncology Issues: Vol. 25, No. 5, pp. 24-25.

Health-Care Reform 2010: How Will It Impact You and Your Practice?

There are several transformative features of the 2 landmark health-care reform laws passed by the Congress and signed into law by the President in March. The most critical elements that will impact pharmacists and patients are categorized into 6 key areas in this commentary: health insurance reform; improvements in Medicare and Medicaid; pharmacy practice expansion; health professions education and workforce initiatives; prevention and wellness; and enhanced access to affordable medications. The relevant features of these new opportunities are presented and the implications for pharmacists and their patients are discussed.

Moving interprofessional learning forward through formal assessment

There is increasing agreement that graduates who finish tertiary education with the full complement of skills and knowledge required for their designated profession are not 'work-ready' unless they also acquire interpersonal, collaborative practice and team-working capabilities. Health workers are unable to contribute to organisational culture in a positive way unless they too attain these capabilities. These capabilities have been shown to improve health care in terms of patient safety, worker satisfaction and health service efficiency. Given the importance of interprofessional learning (IPL) which seeks to address these capabilities, why is IPL not consistently embedded into the education of undergraduates, postgraduates and vocationally qualified personnel through formal assessment? This paper offers an argument for the formal assessment of IPL. It illustrates how the interests of the many stakeholders in IPL can benefit from, and contribute to, the integration of IPL into mainstream professional development and tertiary education. It offers practical examples of assessment in IPL which could drive learning and offer authentic, contextual teaching and learning experiences to undergraduates and health workers alike. Assessment drives learning and without formal assessment IPL will continue to be viewed as an optional topic of little relative importance for learners. In order to make the next step forward, IPL needs to be recognised and endorsed through formal assessment, both at the tertiary education level and within the workplace environment. This is supported by workforce initiatives and tertiary education policy which can be used to specify the capabilities or generic skills necessary for effective teamwork and collaborative practice.