The need for a pan Canadian Health Human Resource Strategy

1. The need for a pan Canadian Health Human Resource Strategy Dr. Ivy Lynn Bourgeault CIHR Research Chair in Gender, Work & Health Human Resources ivy.bourgeault@uottawa.ca

2. Importance of health workforce research • The management of the health workforce and its associated and expanding wage bill is the most pressing challenge for health system planners in Canada. • The health workforce constitutes arguably the most important and costly inputs in health care. • There is increasing concern whether the supply of HHR will be able to meet not only future health system’s demand but also population health needs. • How policy, planning and management effectively align with this key resource will be integral to the sustainability of universally accessible health care.

4. The Health Care Division of Labour is a Complex, Adaptive System • Complex adaptive systems – entities with multiple, diverse and interconnected elements • often accompanied by feedback effects, nonlinearity and other conditions that add to its unpredictability http://www.change-ability.ca/Complex_Adaptive.pdf

5. Three fundamental questions will be addressed: • What is the justification for a coordinated Canadian HHR strategy? • What would be the substance of a Canadian HHR strategy? • How might a Canadian HHR strategy be best implemented?

6. Three fundamental questions will be addressed: • What is the justification for a coordinated Canadian HHR strategy? • What would be the substance of a Canadian HHR strategy? • How might a Canadian HHR strategy be best implemented?

7. “The status quo approach to planning has the potential to create both financial and political risks, to limit each jurisdiction’s ability to develop effective sustainable health delivery systems and the health human resources to support those systems” (ACHDHR, 2007, p. 5).

8. problems with supply concerns the numbers of health care professionals providing services to a population problems with mix concerns the relative numbers of health care professionals providing various types of services problems with distribution concerns the location or deployment of health care professionals HHR Policy Problems:

9. Problem with Supply: • “Shortages” • when persons with legitimate needs for care must wait long times or travel long distances, or do without • “Surpluses” • providers do not have enough legitimate work to keep them busy – under and unemployed • Traditional approaches to HHR planning in Canada have resulted in cycles of over and under supply, high turnover and attrition, and a lack of stability in the health workforce. • They have also done little to address the persistent problems with health workforce distribution in alignment with population health needs.

10. Problem with Distribution • Largely geographic (urban/rural/remote) but also sector(e.g., long term care) • Access to linguistic and culturally appropriate health care services • Explanations for these problems: • issues of lifestyle and nature of work • the changing “needs” of the population • the high degree of specialization • Budgetary constraints

11. Problems with “Mix” • Within professions • GP/FPs and specialists, implications of superspecialization • Shortages of specific types of physicians; surpluses of others the “lack of national (and few provincial) mechanisms to channel new graduates into the specialties where they are likely to be most needed rather than specialties most needed by teaching hospitals or most favored by students,” and the lack of “integration between the education system that prepares providers and the health system that employs and deploys them” (Barer, 2013)

12. Problems with “Mix” • Between professions • Models of care • New and overlapping scopes of practice? • Increase GP roles – GP anaesthetists, GP obstetricians • Expanded roles - APN - Clinical nurse specialists & Nurse Practitioners • New roles – midwives, PAs, pharmacy technicians, etc.

13. Canadian HHR Context • The HHR landscape in Canada presently includes a range of organizations and stakeholder groups but they are often working in either professional or jurisdictional isolation. There is a need to coordinate and create effective collaborative linkages amongst these groups. • Moreover, none of these organizations have as their explicit mandate to act as an independent, arms-length knowledge broker linking HHR researchers and other knowledge producers and a range of knowledge users and clinical and system decision-makers and managers involved in HHR policy and planning. • There has also been no ready coordinative mechanism to translate international ideas and innovations to the Canadian context

14. Three fundamental questions will be addressed: • What is the justification for a coordinated Canadian HHR strategy? • What would be the substance of a Canadian HHR strategy? • How might a Canadian HHR strategy be best implemented?

15. Element of an HHR Strategy • Creating a consensus HHR framework to reflect a common understanding of the key inputs, outputs, and goals/outcomes of an integrated HHR planning and deployment system to galvanize stakeholder support and foster collective action and evaluation. • Coordinating and enhancing an HHR evidence infrastructure to support health workforce research and decision-making that align with the collective goals of the consensus framework. • Developing a coordinated HHR action plan with evaluation, governance, and accountability targets that identifies the critical challenges that need to be addressed across the country, along with a set of short, medium, and long-term goals for each that will include measures and indicators to monitor the progress across jurisdictions.

17. An HHR evidence infrastructure • A number of HHR stakeholders in Canada have suggested “a national centre dedicated to assisting with the coordination of health workforce planning efforts across jurisdictions including a central location for collection and analysis of health workforce data that is independent and provides arms-length, evidence informed advice and cohesive reports to help address health workforce issues that have impact across jurisdictional boundaries” (IHWC Report, 2014, p. 7).

18. International HHR Context • Most countries have created some type of health workforce organization to improve the performance of their health systems. • This includes other federated nations like Australia and the US are resolving jurisdictional matters enabling them to establish national health workforce agencies as networks of cooperation. • These organizations, according to a 2011 review by the WHO, “collect, analyze and disseminate data and information on the health workforce and the labor market, conduct applied research and produce knowledge, contribute to policy development, contribute to building capacity and understanding of HRH issues and advocate/ facilitate the dialogue between stakeholders.” (p.2). (2011 WHO Background Paper Human Resources for Health Observatories: An Overview, p. 2)

19. Three fundamental questions will be addressed: • What is the justification for a coordinated Canadian HHR strategy? • What would be the substance of a Canadian HHR strategy? • How might a Canadian HHR strategy be best implemented?

20. “The success of the framework and the action plan depends on the commitment of all involved in making the transition from the status quo to a more collaborative approach. The critical success factors to applying the framework and building that commitment are: • Appropriate stakeholder engagement • Strong leadership and adequate resources • Clear understanding of roles and responsibilities • A focus on cross-jurisdictional issues • A change in system or organizational culture • Flexibility • Accountability” (ACHDHR, 2007, pp. 12–13)

21. Thank you For more information, please see: www.hhr-rhs.ca