A Public Policy Perspective on Educational Credentials for Health Professions

1. A Public Policy Perspective onEducational Credentials for Health Professions Steven Lewis Access Consulting Ltd., Saskatoon & Centre for Health & Policy Studies University of Calgary CAAHP Conference Ottawa, April 4, 2003

2. The Current Health Care Scene • Higher degree of specialization • Greater technical sophistication • Sicker institutional populations • Rapid change • HHR shortages • Increased urbanization

3. HHR Problems • Mismatch of need and supply • Aging workforce • Maldistribution of personnel • Inefficient division of labour • Slow development of team concept • Long production cycles for personnel

4. Some Major Questions • Job-readiness: what does it mean and who is responsible? • Which educational programs can be most responsive to changing workplace needs? • Educating for a short half-life of knowledge • Credentials: whom do they serve and should educational programs pile them on?

5. Educational Issues • Costs (to system, to students) • Shelf life—how long does initial education last in a rapidly changing practice and scientific milieu? • Structure • Relative importance of theory and practice • Traditional vs. co-op programs • Continuous vs. modular programs • Impact on career development

6. The Knowledge Paradox • Health care more knowledge-intensive than ever, promoting specialization • The greater the requirement for knowledge, the less time available for problem-solving and creativity • The knowledge base changes constantly • Dilemma: • How much is enough for new graduates? • How should problem-solving be taught?

7. Educating People to Embrace Change • Most people hate change • Educational institutions really hate change and their structures are admirably designed to thwart it • You cannot manage successfully in health care unless you can manage change • Neither change nor change management are integral aspects of health science education

8. What Do Students Want? • Jobs that use their skills • Portable and respected credentials • Opportunities to continue education • Opportunities for career advancement • Lowest possible direct costs • Shortest time possible

9. What Does Government Want? • High quality, low cost programs • Short production cycles • Ability to adjust intake and output rapidly • Graduates qualified to do the job • Programs adaptable to needs of workplace

10. What Do Professions Want? • Well-defined and exclusive scope of practice • Status and respect • Good pay • Access to senior administrative positions • National and international standards • Self-regulation and self-definition

11. What Do Educators Want? • High quality, sustainable programs • Good students • Respect from their peers • Opportunities to do research (some) • Prospects for career advancement • Security and stability

12. What Do Employers Want? • Job-ready graduates • Organizational competence • Good match of education with requirements of the job • Large pool of qualified applicants to fill positions • Portable national credentials and standards

13. The Interests At Play

14. What Drives “Credential Creep”? • Almost invariably generated by the occupational groups themselves • Governments’ initial reactions almost invariably negative • Employers often not consulted and when they are, often skeptical of the change • Research-based evidence rarely available or influential in the decisions

15. Problems Enhanced Credentials Ostensibly Solve (if they exist) • Inadequate job skills—unprepared graduates • Development of new kinds of skills—better match with needs of contemporary practice • Need to attract “better” students • Failure to be taken seriously as integral parat of health care team • Need to educate students in a different environment alongside their future colleagues

16. Possible Justifications for Raising Credentials • Desire of current members of the profession • Interests and desires of educational programs • Views and interests of employers • Views and interests of governments • Empirical evidence that status quo is unsatisfactory • Empirical evidence that enhanced credentials will solve the problems identified

17. Impact of Increasing Credentials

18. What Does “Job-Ready” Mean? • Health system jobs are not static • Knowledge base changes very rapidly • Success depends on: • Adaptability • Judgment in face of uncertainty • Ability to find, synthesize and apply new knowledge • Ability to communicate

19. Are Higher Credentials Justifiable? • Evidentiary basis for changing credentials is weak or non-existent • No evidence produced to suggest that diploma nurses were or are unable to do the job • May be indirect rationale, e.g., as ticket to higher management positions • Natural tendency for occupational groups to want to upgrade their status

20. Changing Programs or Changing Venues—or Both • All professions becoming more knowledge-intensive • Information management is supplanting technical-physical skills • All educational programs must be in the business of information management and analysis • When do needs warrant conversion to a university-based program? • Who should decide, and on what basis?

21. The “Critical Thinking” Rationale • Some argue university-based programs add value in form of critical thinking and judgment • Assumes that formal education rather than job experience and apprenticeship creates these qualities • Assumes that college-based programs do not or cannot develop these capacities • Quality control in universities is arguably uneven at the undergraduate level

22. The Dangers of Misalignment • Contentment arises partly from good match of education and job requirements • Higher credentials may create unrealistic expectations in workforce • Career advancement may require a different knowledge base, not simply an expanded one • Important to track the impact of new standards on job satisfaction

23. Credentials as Pathway to Career Advancement • Contemporary world is inordinately focused on formal educational credentials • Upward career path does require different skill set (human and financial management, judgement, big-picture and synthetic view of organization) • Changing from diploma to degree unlikely to be the best route to acquiring these capacities • Timing is an issue—often better to return to school when needs and ambitions clarify

24. Initial Credentials and Lifelong Learning • A great deal of health care knowledge is obsolete in 5 or 10 years • Science and technology advance rapidly • Suggests that techniques of learning, not just a body of knowledge, are the real mandates of health science education programs • These trajectories will blur the distinction between colleges and universities • Requires new understanding of time horizons

25. Assessing Credential Needs: A Public Interest Checklist • Do requirements match needs of workplace? • Do requirements create unnecessary barriers to entry? • Is there evidence that current programs do not produce suitable graduates? • Do educational shortcomings require normal and continuous adaptation or wholesale redesign?

26. Public Interest Checklist (continued) • How much would raising the requirements cost, and who would bear the cost? • Who is making the case for raising credentials, and on what evidence or argument? • What process led to the conclusion that credentials should be raised—was it inclusive and transparent? • Will raising credentials actually solve the problems identified?

27. Conclusion • A public interest and public policy perspective places credentialism in wider context • Reconciling public and particular interests not always possible • Crucial to ensure solutions fit problems • If key constituencies are ignored, the result is likely to be sub-optimal • Important to learn from experiences to date

28. Contact Information Steven Lewis Access Consulting Ltd. 211-4th Avenue South Saskatoon SK S7K 1N1 Tel. 306-343-1007 Fax. 306-343-1071 E-mail: Steven.Lewis@shaw.ca