Forecasting models for human resources in health care

Seemingly unrelated time series model for forecasting the peak and short-term electricity demand: Evidence from the Kalman filtered Monte Carlo method

In this extant paper, a multivariate time series model using the seemingly unrelated times series equation (SUTSE) framework is proposed to forecast the peak and short-term electricity demand using time series data from February 2, 2014, to August 2, 2018. Further the Markov Chain Monte Carlo (MCMC) method, Gibbs Sampler, together with the Kalman Filter were applied to the SUTSE model to simulate the variances to predict the next day's peak and electricity demand. Relying on the study results, the running ergodic mean showed the convergence of the MCMC process. Before forecasting the peak and short-term electricity demand, a week's prediction from the 28th to the 2nd of August of 2018 was analyzed and it found that there is a possible decrease in the daily energy over time. Further, the forecast for the next day (August 3, 2018) was about 2187 MW and 44090 MWh for the peak and electricity demands respectively. Finally, the robustness of the SUTSE model was assessed in comparison to the SUTSE model without MCMC. Evidently, SUTSE with the MCMC method had recorded an accuracy of about 96% and 95.8% for Peak demand and daily energy respectively.

Planning human resources and facilities to achieve Sustainable Development Goals: a decision-analytical modelling approach to predict cancer control requirements in Indonesia

Objectives

Indonesia aims to achieve universal health coverage (UHC) and Sustainable Development Goals (SDGs), including SDG 3 target 4, which focuses on cancer control, by 2030. This study aimed to forecast the human resources for health (HRH) and facilities required for cancer control in Indonesia over an 11-year period to support these goals.

Design

A two-stage Markov model was developed to forecast the demand side of facilities and HRH requirements for cancer control in Indonesia over an 11-year period.

Setting

Data sources used include the Indonesia Health Profile Report (2019), the Indonesian Radiation Oncology Society Database and National Cancer Control Committee documents (2019).

Methods

The study involved modelling the current availability of HRH and healthcare facilities in Indonesia and predicting future requirements. The gap between the current and the required HRH and facilities related to oncology, and the costs associated with meeting these requirements, were analysed.

Results

Results indicate the need to increase the number of healthcare facilities and HRH to achieve SDG targets. However, UHC for cancer care still may not be achieved, as eastern Indonesia is predicted to have no tertiary hospital until 2030. The forecast shows that Indonesia had a median of only 39% of the HRH requirements in 2019. Closing the HRH gap requires around a 47.6% increase in salary expenditure.

Conclusion

This study demonstrates the application of decision-analytical modelling approach to planning HRH and facilities in the context of a low-to-middle-income country. Scaling up oncology services in Indonesia to attain the SDG targets will require expansion of the number and capability of healthcare facilities and HRH. This work allows an in-depth understanding of the resources needed to achieve UHC and SDGs and could be utilised in other disease areas and contexts.

Healthcare Human Resources: Trends and Demand in Saudi Arabia

This paper estimates the impact of policies on the current status of Healthcare Human Resources (HHR) in Saudi Arabia and explores the initiatives that will be adopted to achieve Saudi Vision 2030. Retrospective time-series data from the Ministry of Health (MOH) and statistical yearbooks between 2003 and 2015 are analyzed to identify the impact of these policies on the health sector and the number of Saudi and non-Saudi physicians, nurses and allied health specialists employed by MOH, Other Government Hospitals (OGH) and Private Sector Hospitals (PSH). Moreover, multiple regressions are performed with respect to project data until 2030 and meaningful inferences are drawn. As a local supply of professional medical falls short of demand, either policy to foster an increase in supply are adopted or the Saudization policies must be relaxed. The discrepancies are identified in terms of a high rate of non-compliance of Saudization in the private sector and this is being countered with alternative measures which are discussed in this paper. The study also analyzed the drivers of HHR demand, supply and discussed the research implications on policy and society. The findings suggest that the 2011 national Saudization policy yielded the desired results mostly regarding allied health specialists and nurses. This study will enable decision-makers in the healthcare sector to measure the effectiveness of the new policies and, hence, whether to continue in implementing them or to revise them.

The health workforce demand: a systematic literature review

Understanding imbalances between the supply and demand of the human resour- ces for health (HRH) is essential for enhancing health outcomes. Addressing the HRH demand is particularly challenging, especially given the deficit of accurate data and surplus of unresolved methodological flaws. This study presents a systematic review of the literature surrounding HRH demand and answers the following key questions: How has HRH demand been addressed? What are the harms and barriers that accompany HRH demand modeling? This systematic review was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) statement. Relevant keywords were used in a thorough search of the PubMed/MEDLINE, SCOPUS, and Web of Science databases. A total of 2,599 papers were retrieved and evaluated according to their title and abstract. Of these, the full-text of 400 papers was analyzed, 53 of which successfully met the inclusion criteria in our study. While the topic's relevance is widespread, it still lacks a validated approach to model HRH demand adequately. The main characteristics of the applied methods are presented, such as their application complexity by health policymakers. Opportunities and orientations for further research are also highlighted.

The needs-based health workforce planning method: a systematic scoping review of analytical applications

Although the theoretical underpinnings and analytical framework for needs-based health workforce planning are well developed and tested, its uptake in national planning processes is still limited. Towards the development of open-access needs-based planning model for national workforce planning, we conducted a systematic scoping review of analytical applications of needs-based health workforce models. Guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses-extension for Scoping Reviews (PRISMA-ScR) checklist, a systematic scoping review was conducted. A systematic search of peer-reviewed literature published in English was undertaken across several databases. Papers retrieved were assessed against predefined inclusion criteria, critically appraised, extracted and synthesized. Twenty-five papers were included, which showed increasing uptake of the needs-based health workforce modelling, with 84% of the studies published within the last decade (2010-20). Three countries (Canada, Australia and England) accounted for 48% of the publications included whilst four studies (16%) were based on low-and-middle-income countries. Only three of the studies were conducted in sub-Saharan Africa. Most of the studies (36%) reported analytical applications for specific disease areas/programs at sub-national levels; 20% focused on the health system need for particular categories of health workers, and only two (8%) reported the analytical application of the needs-based health workforce approach at the level of a national health system across several disease areas/programs. Amongst the studies that conducted long-term projections, the time horizon of the projection was an average of 17 years, ranging from 3 to 33 years. Most of these studies had a minimum time horizon of 10 years. Across the studies, we synthesized six typical methodological considerations for advancing needs-based health workforce modelling. As countries aspire to align health workforce investments with population health needs, the need for some level of methodological harmonization, open-access needs-based models and guidelines for policy-oriented country-level use is not only imperative but urgent.

Advancing the Population Needs-Based Health Workforce Planning Methodology: A Simulation Tool for Country Application

Although the conceptual underpinnings of needs-based health workforce planning have developed over the last two decades, lingering gaps in empirical models and lack of open access tools have partly constrained its uptake in health workforce planning processes in countries. This paper presents an advanced empirical framework for the need-based approach to health workforce planning with an open-access simulation tool in Microsoft^® Excel to facilitate real-life health workforce planning in countries. Two fundamental mathematical models are used to quantify the supply of, and need for, health professionals, respectively. The supply-side model is based on a stock-and-flow process, and the need-side model extents a previously published analytical frameworks using the population health needs-based approach. We integrate the supply and need analyses by comparing them to establish the gaps in both absolute and relative terms, and then explore their cost implications for health workforce policy and strategy. To illustrate its use, the model was used to simulate a real-life example using midwives and obstetricians/gynaecologists in the context of maternal and new-born care in Ghana. Sensitivity analysis showed that if a constant level of health was assumed (as in previous works), the need for health professionals could have been underestimated in the long-term. Towards universal health coverage, the findings reveal a need to adopt the need-based approach for HWF planning and to adjust HWF supply in line with population health needs.

A predictive model and country risk assessment for COVID-19: An application of the Limited Failure Population concept

This article provides predictions for the spread of the SARS-CoV-2 virus for a number of European countries and the United States of America, drawing from their different profiles, both socioeconomically and in terms of outbreak and response to the 2019-2020 coronavirus pandemic, from an engineering and data science perspective. Each country is separately analysed, due to their differences in populations density, cultural habits, health care systems, protective measures, etc. The probabilistic analysis is based on actual data, as provided by the World Health Organization (WHO), as of May 1, 2020. The deployed predictive model provides analytical expressions for the cumulative density function of COVID-19 curve and estimations of the proportion of infected subpopulation for each country. The latter is used to define a Risk Index, towards assessing the level of risk for a country to exhibit high rates of COVID-19 cases after a given interval of observation and given the plans of lifting lockdown measures.

Using system dynamics modelling to show the effect of nurse workload on nurses' health and quality of care

The objective of the current study is to explore System Dynamics modelling to quantify and understand the effects of nursing workload on nurse burnout, absenteeism, and quality of patient care. A literature search was performed to identify the causal relationships between factors related to the problem and build a conceptual causal loop diagram. Each of these factors was then operationalised and a simulation model was built using quantitative empirical data from the literature, supplemented with expert input. The model results showed that long nurse shifts and work weeks double nurse fatigue levels, while increasing burnout by up to 6 times, absenteeism by up to 5 times, and medical errors for the patients increasing by up to 150%. The study demonstrates a novel application of System Dynamics in healthcare to examine the impact of management strategies and healthcare system design on nurses' wellbeing and on care quality. Practitioner summary: System Dynamics Modelling allows for the integration of available scientific evidence and expertise to reveal the relationship between nurse workload, burnout and care quality in terms of medical errors. Such models can reveal possible responses from proposed policy or system design changes that could not be quantified with conventional approaches. Abbreviations: HF: human factors; SD: system dynamics; CLD: causal loop diagram; OFAT: one factor at a time.

Forecasting maldistribution of human resources for healthcare and patients in Japan: a utilization-based approach

BACKGROUND

Hokkaido's demographic trend of population decrease with aging population is remarkable even in Japan. Although healthcare policy decision-makers need to appropriately allocate resources while grasping regional demands, not much is available on whether medical demand would increase or not for future. In addition, little is known about what impact will current situation have on future demand-supply balance and equality by regions. This study aims to support decision-making in human resource planning for coping with changing population structure by forecasting future demand, and evaluation those regional maldistributions.

METHOD

We set patients with acute myocardial infarction or cerebral stroke, and all medical care as study subjects and analyzed for 2015, 2025, and 2035 in Hokkaido and each Secondary Medical Care Area. We used a utilization-based approach to estimate the healthcare supply-demand balance in the future. Moreover, we evaluated the regional maldistribution of demand-supply balance by calculating Herfindahl-Hirschman Index, Gini Coefficients, the number of physicians/specialists per patient. Moreover, we conducted sensitivity analysis to evaluation impact on aspects of demand-supply balance by uncertainty of utilization for future.

RESULTS

Our results displayed that concentration of patients will progress, while regional distribution will shrink in all subject. However, from comparison based on all medical care, Gini Coefficients of acute myocardial infarction and cerebral stroke has always been high. This suggest that the resource allocation of them has room for improvement. In addition, our analysis showed the change in this balance will differ in each region in the future. Moreover, demographic change will not consistent with the number of patient change from 2015 to 2035.

CONCLUSION

These results suggest policy planners should use the number of patient by disease, by region as indicator of demand, instead of provider-to-population ratios being in use today. The result of our sensitivity analysis show two findings. First, the range of each indicator have possible for future. Second, increase of utilization, for instance lowing barrier in the use by development operation of patient transportation in AMI/CS, would improve maldistribution of opportunity for resident to get emergency medical services.

A dynamic, multi-professional, needs-based simulation model to inform human resources for health planning

BACKGROUND

As population health needs become more complex, addressing those needs increasingly requires the knowledge, skills, and judgment of multiple types of human resources for health (HRH) working interdependently. A growing emphasis on team-delivered health care is evident in several jurisdictions, including those in Canada. However, the most commonly used HRH planning models across Canada and other countries lack the capacity to plan for more than one type of HRH in an integrated manner. The purpose of this paper is to present a dynamic, multi-professional, needs-based simulation model to inform HRH planning and demonstrate the importance of two of its parameters-division of work and clinical focus-which have received comparatively little attention in HRH research to date.

METHODS

The model estimates HRH requirements by combining features of two previously published needs-based approaches to HRH planning-a dynamic approach designed to plan for a single type of HRH at a time and a multi-professional approach designed to compare HRH supply with requirements at a single point in time. The supplies of different types of HRH are estimated using a stock-and-flow approach.

RESULTS

The model makes explicit two planning parameters-the division of work across different types of HRH, and the degree of clinical focus among individual types of HRH-which have previously received little attention in the HRH literature. Examples of the impacts of these parameters on HRH planning scenarios are provided to illustrate how failure to account for them may over- or under-estimate the size of any gaps between the supply of and requirements for HRH.

CONCLUSION

This paper presents a dynamic, multi-professional, needs-based simulation model which can be used to inform HRH planning in different contexts. To facilitate its application by readers, this includes the definition of each parameter and specification of the mathematical relationships between them.

Addressing the Licensed Doctor Maldistribution in China: A Demand-And-Supply Perspective

Background: The maldistribution of licensed doctors is one of the major challenges faced by the Chinese health sector. However, this subject remains underexplored, as the underlying causes of licensed doctor distribution have not been fully mapped out. To fill the research void, this study theoretically modeled and empirically measured various determinants of licensed doctor distribution from both the supply and demand sides while taking the spillover effect between the adjacent geographical units into consideration. Methods: The theory of demand and supply is adopted to construct a research framework so as to explain the imbalance in the licensed doctor distribution. Both direct effects and spillover effects of the supply-side factors and demand-side factors are empirically measured with the spatial panel econometric models. Results: The health service demand was found, as expected, to be the major driving force of the licensed doctor distribution across the nation. That is, the increase in health services demands in a province could significantly help one unit attract licensed doctors from adjacent units. Unexpectedly but intriguingly, the medical education capacity showed a relatively limited effect on increasing the licensed doctor density in local units compared with its spillover effect on neighboring units. In addition, government and social health expenditures played different roles in the health labor market, the former being more effective in increasing the stock of clinicians and public health doctors, the latter doing better in attracting dentists and general practitioners. Conclusions: The results provide directions for Chinese policy makers to formulate more effective policies, including a series of measures to boost the licensed doctor stock in disadvantaged areas, such as the increase of government or social health expenditures, more quotas for medical universities, and the prevention of a brain drain of licensed doctors.

Developing a Sustainable Long-Term Ageing Health Care System Using the DANP-mV Model: Empirical Case of Taiwan

Most of the baby boomers born after the Second World War (WWII) have passed the age of 65, meaning they have gradually lost their social functions and positions, and are facing the need for care. In Taiwan, the lack of a long-term care mechanism is having a certain degree of impact on society as a whole, and thus, it is important to have a mechanism to take care of the elderly. In order to make this system sustainable, sufficient funds and continuous improvement are important factors. In the past, in order to avoid the illegal transfer of benefits, the social welfare mechanism avoided the use of for-profit organizations. However, as the economic environment declines, the role of for-profit organizations should be considered. This study defines the long-term ageing health care system using five major dimensions and 20 criteria. The DANP-mV model was used to analyze Taiwan’s current system and identify problems, and then to develop a continuous improvement strategy from the perspective of the source of the problem in order to improve long-term ageing health care.

Workforce requirements in rheumatology: a systematic literature review informing the development of a workforce prediction risk of bias tool and the EULAR points to consider

OBJECTIVE

To summarise the available information on physician workforce modelling, to develop a rheumatology workforce prediction risk of bias tool and to apply it to existing studies in rheumatology.

METHODS

A systematic literature review (SLR) was performed in key electronic databases (1946-2017) comprising an update of an SLR in rheumatology and a hierarchical SLR in other medical fields. Data on the type of workforce prediction models and the factors considered in the models were extracted. Key general as well as specific need/demand and supply factors for workforce calculation in rheumatology were identified. The workforce prediction risk of bias tool was developed and applied to existing workforce studies in rheumatology.

RESULTS

In total, 14 studies in rheumatology and 10 studies in other medical fields were included. Studies used a variety of prediction models based on a heterogeneous set of need/demand and/or supply factors. Only two studies attempted empirical validation of the prediction quality of the model. Based on evidence and consensus, the newly developed risk of bias tool includes 21 factors (general, need/demand and supply). The majority of studies revealed high or moderate risk of bias for most of the factors.

CONCLUSIONS

The existing evidence on workforce prediction in rheumatology is scarce, heterogeneous and at moderate or high risk of bias. The new risk of bias tool should enable future evaluation of workforce prediction studies. This review informs the European League Against Rheumatism points to consider for the conduction of workforce requirement studies in rheumatology.

A labor requirements function for sizing the health workforce

BACKGROUND

Ensuring healthcare delivery is dependent both on the prediction of the future demand for healthcare services and on the estimation and planning for the Health Human Resources needed to properly deliver these services. Although the Health Human Resources planning is a fascinating and widely researched topic, and despite the number of methodologies that have been used, no consensus on the best way of planning the future workforce requirements has been reported in the literature. This paper aims to contribute to the extension and diversity of the range of available methods to forecast the demand for Health Human Resources and assist in tackling the challenge of translating healthcare services to workforce requirements.

METHODS

A method to empirically quantify the relation between healthcare services and Health Human Resources requirements is proposed. For each one of the three groups of specialties identified-Surgical specialties, Medical specialties and Diagnostic specialties (e.g., pathologists)-a Labor Requirements Function relating the number of physicians with a set of specialty-specific workload and capital variables is developed. This approach, which assumes that health managers and decision-makers control the labor levels more easily than they control the amount of healthcare services demanded, is then applied to a panel dataset comprising information on 142 public hospitals, during a 12-year period.

RESULTS

This method provides interesting insights on healthcare services delivery: the number of physicians required to meet expected variations in the demand for healthcare, the effect of the technological progress on healthcare services delivery, the time spent on each type of care, the impact of Human Resources concentration on productivity, and the possible resource allocations given the opportunity cost of the physicians' labor.

CONCLUSIONS

The empirical method proposed is simple and flexible and produces statistically strong models to estimate Health Human Resources requirements. Moreover, it can enable a more informed allocation of the available resources and help to achieve a more efficient delivery of healthcare services.

Forecast of Healthcare Facilities and Health Workforce Requirements for the Public Sector in Ghana, 2016-2026

Background: Ghana is implementing activities towards universal health coverage (UHC) as well as the attainment of the health-related Sustainable Development Goals (SDGs) by the health sector by the year 2030. Aside lack of empirical forecast of the required healthcare facilities to achieve these mandates, health workforce deficits are also a major threat. We therefore modelled the needed healthcare facilities in Ghana and translated it into year-by-year staffing requirements based on established staffing standards.

Methods: Two levels of modelling were used. First, a predictive model based on Markov processes was used to estimate the future healthcare facilities needed in Ghana. Second, the projected healthcare facilities were translated into aggregate staffing requirements using staffing standards developed by Ghana’s Ministry of Health (MoH).

Results: The forecast shows a need to expand the number/capacity of healthcare facilities in order to attain UHC. All things being equal, the requisite healthcare infrastructure for UHC would be attainable from 2023. The forecast also shows wide variations in staffing-need-availability rate, ranging from 15% to 94% (average being 68%) across the various staff types. Thus, there are serious shortages of staff which are worse amongst specialists.

Conclusion: Ghana needs to expand and/or increase the number of healthcare facilities to facilitate the attainment of UHC. Also, only about 68% of the health workforce (HWF) requirements are employed and available for service delivery, leaving serious shortages of the essential health professionals. Immediate recruitment of unemployed but qualified health workers is therefore imperative. Also, addressing health worker productivity, equitable distribution of existing workers, and attrition may be the immediate steps to take whilst a long-term commitment to comprehensively address HWF challenges, including recruitments, expansion and streamlining of HWF training, is pursued.

The never ending road: improving, adapting and refining a needs-based model to estimate future general practitioner requirements in two Australian states

BACKGROUND

Health workforce planning models have been developed to estimate the future health workforce requirements for a population whom they serve and have been used to inform policy decisions.

OBJECTIVES

To adapt and further develop a need-based GP workforce simulation model to incorporate current and estimated geographic distribution of patients and GPs.

METHODS

A need-based simulation model that estimates the supply of GPs and levels of services required in South Australia (SA) was adapted and applied to the Western Australian (WA) workforce. The main outcome measure was the differences in the number of full-time equivalent (FTE) GPs supplied and required from 2013 to 2033.

RESULTS

The base scenario estimated a shortage of GPs in WA from 2019 onwards with a shortage of 493 FTE GPs in 2033, while for SA, estimates showed an oversupply over the projection period. The WA urban and rural models estimated an urban shortage of GPs over this period. A reduced international medical graduate recruitment scenario resulted in estimated shortfalls of GPs by 2033 for WA and SA. The WA-specific scenarios of lower population projections and registrar work value resulted in a reduced shortage of FTE GPs in 2033, while unfilled training places increased the shortfall of FTE GPs in 2033.

CONCLUSIONS

The simulation model incorporates contextual differences to its structure that allows within and cross jurisdictional comparisons of workforce estimations. It also provides greater insights into the drivers of supply and demand and the impact of changes in workforce policy, promoting more informed decision-making.

Forecasting the demand for radiology services

Since the demand for health services is the key driver for virtually all of a health care organisation's financial and operational activities, it is imperative that health care managers invest the time and effort to develop appropriate and accessible forecasting models for their facility's services. In this article, we analyse and forecast the demand for radiology services at a large, tertiary hospital in Florida. We demonstrate that a comprehensive and accurate forecasting model can be constructed using well-known statistical techniques. We then use our model to illustrate how to provide decision support for radiology managers with respect to department staffing. The methodology we present is not limited to radiology services and we advocate for more routine and widespread use of demand forecasting throughout the health care delivery system.

A scoping review of nursing workforce planning and forecasting research

AIM

This study will critically evaluate forecasting models and their content in workforce planning policies for nursing professionals and to highlight the strengths and the weaknesses of existing approaches.

BACKGROUND

Although macro-level nursing workforce issues may not be the first thing that many nurse managers consider in daily operations, the current and impending nursing shortage in many countries makes nursing specific models for workforce forecasting important.

METHOD

A scoping review was conducted using a directed and summative content analysis approach to capture supply and demand analytic methods of nurse workforce planning and forecasting. The literature on nurse workforce forecasting studies published in peer-reviewed journals as well as in grey literature was included in the scoping review.

RESULTS

Thirty six studies met the inclusion criteria, with the majority coming from the USA. Forecasting methods were biased towards service utilization analyses and were not consistent across studies.

CONCLUSION

Current methods for nurse workforce forecasting are inconsistent and have not accounted sufficiently for socioeconomic and political factors that can influence workforce projections. Additional studies examining past trends are needed to improve future modelling.

IMPLICATIONS FOR NURSING MANAGEMENT

Accurate nursing workforce forecasting can help nurse managers, administrators and policy makers to understand the supply and demand of the workforce to prepare and maintain an adequate and competent current and future workforce.

A supply model for nurse workforce projection in Malaysia

The paper aims to provide an insight into the significance of having a simulation model to forecast the supply of registered nurses for health workforce planning policy using System Dynamics. A model is highly in demand to predict the workforce demand for nurses in the future, which it supports for complete development of a needs-based nurse workforce projection using Malaysia as a case study. The supply model consists of three sub-models to forecast the number of registered nurses for the next 15 years: training model, population model and Full Time Equivalent (FTE) model. In fact, the training model is for predicting the number of newly registered nurses after training is completed. Furthermore, the population model is for indicating the number of registered nurses in the nation and the FTE model is useful for counting the number of registered nurses with direct patient care. Each model is described in detail with the logical connection and mathematical governing equation for accurate forecasting. The supply model is validated using error analysis approach in terms of the root mean square percent error and the Theil inequality statistics, which is mportant for evaluating the simulation results. Moreover, the output of simulation results provides a useful insight for policy makers as a what-if analysis is conducted. Some recommendations are proposed in order to deal with the nursing deficit. It must be noted that the results from the simulation model will be used for the next stage of the Needs-Based Nurse Workforce projection project. The impact of this study is that it provides the ability for greater planning and policy making with better predictions.

Internationally Educated Health Professionals in Canada: Navigating Three Policy Subsystems Along the Pathway to Practice

The integration of internationally educated health professionals (IEHPs) into the health workforces of their adopted countries is an issue that has challenged policy makers and policy scholars for decades. In this article, the authors explore the implications of the ideological underpinnings of the policy subsystems that IEHPs must navigate in seeking employment in Canada, with a focus on Ontario.Using a policy subsystem approach, in 2015 the authors analyzed a large preexisting data set composed of articles, governmental reports, Web sites, and transcripts of interviews and focus groups conducted in Ontario with IEHPs, health care executives, human resource managers, and job counselors to IEHPs. Through this analysis, they identified three policy subsystems-the immigration system, the educational and licensure/regulatory system, and the health human resources system-that conflict ideologically and, as a result, create barriers to IEHP integration.To make substantive progress on IEHP integration in Canada, four questions should be considered. First, how can researchers bring new research methods to bear to explore why no jurisdiction has been able to create an integrated pathway to practice for IEHPs? Second, how and to what end are the institutions within the three policy subsystems regulating the IEHP pathway to practice? Third, how might the educational and licensure/regulatory policy subsystem create alternative health care employment options for IEHPs? Finally, how might health professions educators pursue a leadership role in the creation of an overarching institution to manage the pathway to practice for IEHPs?

Training and deployment of medical doctors in Tanzania post-1990s health sector reforms: assessing the achievements

BACKGROUND

The shortage of a skilled health workforce is a global crisis. International efforts to combat the crisis have shown few benefits; therefore, more country-specific efforts are required. Tanzania adopted health sector reforms in the 1990s to ensure, among other things, availability of an adequate skilled health workforce. Little is documented on how the post-reform training and deployment of medical doctors (MDs) have contributed to resolving Tanzania's shortage of doctors. The study aims to assess achievements in training and deployment of MDs in Tanzania about 20 years since the 1990s health sector reforms.

METHODS

We developed a human resource for health (HRH) conceptual model to study achievements in the training and deployment of MDs by using the concepts of supply and demand. We analysed secondary data to document the number of MDs trained in Tanzania and abroad, and the number of MDs recommended for the health sector from 1992 to 2011. A cross-sectional survey conducted in all regions of the country established the number of MDs available by 2011.

RESULTS

By 1992, Tanzania had 1265 MDs working in the country. From 1992 to 2010, 2622 MDs graduated both locally and abroad. This translates into 3887 MDs by 2011. Tanzania needs between 3326 and 5535 MDs. Our survey captured 1299 MDs working throughout the country. This number is less than 40% of all MDs trained in and needed for Tanzania by 2011. Maldistribution favouring big cities was evident; the eastern zone with less than 30% of the population hosts more than 50% of all MDs. No information was available on the more than 60% of MDs uncaptured by our survey.

CONCLUSIONS

Two decades after the reforms, the number of MDs trained in Tanzania has increased sevenfold per year. Yet, the number and geographical distribution of MDs practicing in the country has remained the same as before the reforms. HRH planning should consider the three stages of health workforce development conceptualized under the demand and supply model. Auditing and improvement of the HRH database is highly recommended in dealing with Tanzania's MD crisis.

Human resources for health (and rehabilitation): Six Rehab-Workforce Challenges for the century

BACKGROUND

People with disabilities face challenges accessing basic rehabilitation health care. In 2006, the United Nations Convention on the Rights of Persons with Disabilities (CRPD) outlined the global necessity to meet the rehabilitation needs of people with disabilities, but this goal is often challenged by the undersupply and inequitable distribution of rehabilitation workers. While the aggregate study and monitoring of the physical rehabilitation workforce has been mostly ignored by researchers or policy-makers, this paper aims to present the 'challenges and opportunities' for guiding further long-term research and policies on developing the relatively neglected, highly heterogeneous physical rehabilitation workforce.

METHODS

The challenges were identified through a two-phased investigation. Phase 1: critical review of the rehabilitation workforce literature, organized by the availability, accessibility, acceptability and quality (AAAQ) framework. Phase 2: integrate reviewed data into a SWOT framework to identify the strengths and opportunities to be maximized and the weaknesses and threats to be overcome.

RESULTS

The critical review and SWOT analysis have identified the following global situation: (i) needs-based shortages and lack of access to rehabilitation workers, particularly in lower income countries and in rural/remote areas; (ii) deficiencies in the data sources and monitoring structures; and (iii) few exemplary innovations, of both national and international scope, that may help reduce supply-side shortages in underserved areas.

DISCUSSION

Based on the results, we have prioritized the following 'Six Rehab-Workforce Challenges': (1) monitoring supply requirements: accounting for rehabilitation needs and demand; (2) supply data sources: the need for structural improvements; (3) ensuring the study of a whole rehabilitation workforce (i.e. not focused on single professions), including across service levels; (4) staffing underserved locations: the rising of education, attractiveness and tele-service; (5) adapt policy options to different contexts (e.g. rural vs urban), even within a country; and (6) develop international solutions, within an interdependent world.

CONCLUSIONS

Concrete examples of feasible local, global and research action toward meeting the Six Rehab-Workforce Challenges are provided. Altogether, these may help advance a policy and research agenda for ensuring that an adequate rehabilitation workforce can meet the current and future rehabilitation health needs.

Improving the planning of the GP workforce in Australia: a simulation model incorporating work transitions, health need and service usage

BACKGROUND

In Australia, the approach to health workforce planning has been supply-led and resource-driven rather than need-based. The result has been cycles of shortages and oversupply. These approaches have tended to use age and sex projections as a measure of need or demand for health care. Less attention has been given to more complex aspects of the population, such as the increasing proportion of the ageing population and increasing levels of chronic diseases or changes in the mix of health care providers or their productivity levels. These are difficult measures to get right and so are often avoided. This study aims to develop a simulation model for planning the general practice workforce in South Australia that incorporates work transitions, health need and service usage.

METHODS

A simulation model was developed with two sub-models--a supply sub-model and a need sub-model. The supply sub-model comprised three components--training, supply and productivity--and the need sub-model described population size, health needs, service utilisation rates and productivity. A state transition cohort model is used to estimate the future supply of GPs, accounting for entries and exits from the workforce and changes in location and work status. In estimating the required number of GPs, the model used incidence and prevalence data, combined with age, gender and condition-specific utilisation rates. The model was run under alternative assumptions reflecting potential changes in need and utilisation rates over time.

RESULTS

The supply sub-model estimated the number of full-time equivalent (FTE) GP stock in SA for the period 2004-2011 and was similar to the observed data, although it had a tendency to overestimate the GP stock. The three scenarios presented for the demand sub-model resulted in different outcomes for the estimated required number of GPs. For scenario one, where utilisation rates in 2003 were assumed optimal, the model predicted fewer FTE GPs were required than was observed. In scenario 2, where utilisation rates in 2013 were assumed optimal, the model matched observed data, and in scenario 3, which assumed increasing age- and gender-specific needs over time, the model predicted more FTE GPs were required than was observed.

CONCLUSIONS

This study provides a robust methodology for determining supply and demand for one professional group at a state level. The supply sub-model was fitted to accurately represent workforce behaviours. In terms of demand, the scenario analysis showed variation in the estimations under different assumptions that demonstrates the value of monitoring population-based need over time. In the meantime, expert opinion might identify the most relevant scenario to be used in projecting workforce requirements.

Trends in job satisfaction among German nurses from 1990 to 2012

OBJECTIVE

Improving the job satisfaction of nurses is essential to enhance their productivity and retention and to improve patient care. Our aim was to analyse trends in German nurses' job satisfaction to enhance understanding of the nursing labour market and inform future policies.

METHODS

We used 1990-2012 German Socioeconomic Panel data for trends in nurses' job satisfaction. Comparisons were drawn with doctors, other health care workers, and employees in other sectors of employment. Analysis explored associations between job satisfaction trends and other aspects of employment, such as whether full time or part time and pay. To account for fluctuations across the period of analysis, linear trends were generated using ordinary least squares.

RESULTS

Over 23 years, job satisfaction of German nurses underwent a steady and gradual decline, dropping by an average 7.5%, whereas that of doctors and other health care workers increased by 14.4% and 1%, respectively. The decline for part-time nurses (13%) was more pronounced than that for full-time nurses (3%). At the same time, nurses' pay rose by only 3.8% compared to a 23.8% increase for doctors.

CONCLUSIONS

The steady decline in nurses' job satisfaction over the last two decades may be attributable to the multiple reforms and associated policy changes that generally disadvantaged nurses. Contributing factors to job satisfaction decline include lower pay and the demanding and strenuous work environment. Irrespective of the reason, health services researchers, leaders, and policy makers should investigate the reasons for this decline given the forecast growth in work load and complexity of care. Supportive policies for nurses would help enhance the quality and sustainability of German health care.

Future requirements for and supply of ophthalmologists for an aging population in Singapore

BACKGROUND

Singapore's population, as that of many other countries, is aging; this is likely to lead to an increase in eye diseases and the demand for eye care. Since ophthalmologist training is long and expensive, early planning is essential. This paper forecasts workforce and training requirements for Singapore up to the year 2040 under several plausible future scenarios.

METHODS

The Singapore Eye Care Workforce Model was created as a continuous time compartment model with explicit workforce stocks using system dynamics. The model has three modules: prevalence of eye disease, demand, and workforce requirements. The model is used to simulate the prevalence of eye diseases, patient visits, and workforce requirements for the public sector under different scenarios in order to determine training requirements.

RESULTS

Four scenarios were constructed. Under the baseline business-as-usual scenario, the required number of ophthalmologists is projected to increase by 117% from 2015 to 2040. Under the current policy scenario (assuming an increase of service uptake due to increased awareness, availability, and accessibility of eye care services), the increase will be 175%, while under the new model of care scenario (considering the additional effect of providing some services by non-ophthalmologists) the increase will only be 150%. The moderated workload scenario (assuming in addition a reduction of the clinical workload) projects an increase in the required number of ophthalmologists of 192% by 2040. Considering the uncertainties in the projected demand for eye care services, under the business-as-usual scenario, a residency intake of 8-22 residents per year is required, 17-21 under the current policy scenario, 14-18 under the new model of care scenario, and, under the moderated workload scenario, an intake of 18-23 residents per year is required.

CONCLUSIONS

The results show that under all scenarios considered, Singapore's aging and growing population will result in an almost doubling of the number of Singaporeans with eye conditions, a significant increase in public sector eye care demand and, consequently, a greater requirement for ophthalmologists.

Projections of specialist physicians in Mexico: a key element in planning human resources for health

Projections are considered a useful tool in the planning of human resources for health. In Mexico, the supply and demand of specialist doctors are clearly disconnected, and decisions must be made to reduce labour market imbalances. Thus, it is critical to produce reliable projections to assess future interactions between supply and demand. Using a service demand approach, projections of the number of specialist physicians required by the three main public institutions were calculated using the following variables: a) recent recruitment of specialists, b) physician productivity and c) retirement rates. Two types of scenarios were produced: an inertial one with no changes made to current production levels and an alternative scenario adjusted by recommended productivity levels. Results show that institutions must address productivity as a major policy element to act upon in future contracting of specialist physicians. The projections that adjusted for productivity suggest that the hiring trends for surgeons and internists should be maintained or increased to compensate for the increase in demand for services. In contrast, due to the decline in demand for obstetric and paediatric services, the hiring of new obstetrician-gynaecologists and paediatricians should be reduced to align with future demand.

Handling healthcare workforce planning with care: where do we stand?

BACKGROUND

Planning the health-care workforce required to meet the health needs of the population, while providing service levels that maximize the outcome and minimize the financial costs, is a complex task. The problem can be described as assessing the right number of people with the right skills in the right place at the right time, to provide the right services to the right people. The literature available on the subject is vast but sparse, with no consensus established on a definite methodology and technique, making it difficult for the analyst or policy maker to adopt the recent developments or for the academic researcher to improve such a critical field.

METHODS

We revisited more than 60 years of documented research to better understand the chronological and historical evolution of the area and the methodologies that have stood the test of time. The literature review was conducted in electronic publication databases and focuses on conceptual methodologies rather than techniques.

RESULTS

Four different and widely used approaches were found within the scope of supply and three within demand. We elaborated a map systematizing advantages, limitations and assumptions. Moreover, we provide a list of the data requirements necessary to implement each of the methodologies. We have also identified past and current trends in the field and elaborated a proposal on how to integrate the different methodologies.

CONCLUSION

Methodologies abound, but there is still no definite approach to address HHR planning. Recent literature suggests that an integrated approach is the way to solve such a complex problem, as it combines elements both from supply and demand, and more effort should be put in improving that proposal.

Forecasting future needs and optimal allocation of medical residency positions: the Emilia-Romagna Region case study

OBJECTIVES

Italian regional health authorities annually negotiate the number of residency grants to be financed by the National government and the number and mix of supplementary grants to be funded by the regional budget. This study provides regional decision-makers with a requirement model to forecast the future demand of specialists at the regional level.

METHODS

We have developed a system dynamics (SD) model that projects the evolution of the supply of medical specialists and three demand scenarios across the planning horizon (2030). Demand scenarios account for different drivers: demography, service utilization rates (ambulatory care and hospital discharges) and hospital beds. Based on the SD outputs (occupational and training gaps), a mixed integer programming (MIP) model computes potentially effective assignments of medical specialization grants for each year of the projection.

RESULTS

To simulate the allocation of grants, we have compared how regional and national grants can be managed in order to reduce future gaps with respect to current training patterns. The allocation of 25 supplementary grants per year does not appear as effective in reducing expected occupational gaps as the re-modulation of all regional training vacancies.

The implications of the feminization of the primary care physician workforce on service supply: a systematic review

There is a widespread perception that the increasing proportion of female physicians in most developed countries is contributing to a primary care service shortage because females work less and provide less patient care compared with their male counterparts. There has, however, been no comprehensive investigation of the effects of primary care physician (PCP) workforce feminization on service supply. We undertook a systematic review to examine the current evidence that quantifies the effect of feminization on time spent working, intensity and scope of work, and practice characteristics. We searched Medline, Embase, and Web of Science from 1991 to 2013 using variations of the terms 'primary care', 'women', 'manpower', and 'supply and distribution'; screened the abstracts of all articles; and entered those meeting our inclusion criteria into a data abstraction tool. Original research comparing male to female PCPs on measures of years of practice, time spent working, intensity of work, scope of work, or practice characteristics was included. We screened 1,271 unique abstracts and selected 74 studies for full-text review. Of these, 34 met the inclusion criteria. Years of practice, hours of work, intensity of work, scope of work, and practice characteristics featured in 12%, 53%, 42%, 50%, and 21% of studies respectively. Female PCPs self-report fewer hours of work than male PCPs, have fewer patient encounters, and deliver fewer services, but spend longer with their patients during a contact and deal with more separate presenting problems in one visit. They write fewer prescriptions but refer to diagnostic services and specialist physicians more often. The studies included in this review suggest that the feminization of the workforce is likely to have a small negative impact on the availability of primary health care services, and that the drivers of observed differences between male and female PCPs are complex and nuanced. The true scale of the impact of these findings on future effective physician supply is difficult to determine with currently available evidence, given that few studies looked at trends over time, and results from those that did are inconsistent. Additional research examining gender differences in practice patterns and scope of work is warranted.

Forecasting supply and demand in nursing professions: impacts of occupational flexibility and employment structure in Germany

BACKGROUND

In light of Germany's ageing society, demand for nursing professionals is expected to increase in the coming years. This will pose a challenge for policy makers to increase the supply of nursing professionals.

METHODOLOGY

To portray the different possible developments in the supply of nursing professionals, we projected the supply of formally trained nurses and the potential supply of persons who are able to work in a nursing profession. This potential supply of nursing professionals was calculated on the basis of empirical information on occupational mobility provided by the German Microcensus 2005 (Labour Force Survey). We also calculated how the supply of full-time equivalents (FTEs) will develop if current employment structures develop in the direction of employment behaviour in nursing professions in eastern and western Germany. We then compared these different supply scenarios with two demand projections ('status quo' and 'compression of morbidity' scenarios) from Germany's Federal Statistical Office.

RESULTS

Our results show that, even as early as 2005, meeting demand for FTEs in nursing professions was not arithmetically possible when only persons with formal qualification in a nursing profession were taken into account on the supply side. When additional semi-skilled nursing professionals are included in the calculation, a shortage of labour in nursing professions can be expected in 2018 when the employment structure for all nursing professionals remains the same as the employment structure seen in Germany in 2005 (demand: 'status quo scenario'). Furthermore, given an employment structure as in eastern Germany, where more nursing professionals work on a full-time basis with longer working hours, a theoretical shortage of nursing professionals could be delayed until 2024.

CONCLUSIONS

Our analysis of occupational flexibility in the nursing field indicates that additional potential supply could be generated by especially training more young people for a nursing profession as they tend to stay in their initial occupation. Furthermore, the number of FTEs in nursing professions could be increased by promoting more full-time contracts in Western Germany. Additionally, employment contracts for just a small number of weekly working hours (marginal employment) cannot be considered an adequate instrument for keeping formally trained nursing professionals employed in the nursing field.

Service-based health human resources planning for older adults

OBJECTIVES

To test a service-based health human resources (HHR) planning approach for older adults in the context of home and long term care (LTC); to create a practical template/tools for use in various jurisdictions and/or health care settings.

DESIGN

The most serious health needs of seniors in 2 Canadian jurisdictions were identified and linked to the specific services and associated competencies required of health care providers (HCPs) to address those needs. The amounts of each service required were quantified and compared against the capacity of HCPs to perform the services, measured using a self-assessment survey, by using a previously developed analytical framework.

SETTING

Home and LTC sectors in Nova Scotia and Nunavut, Canada.

PARTICIPANTS

Regulated and nonregulated HCPs were invited to complete either an online or paper-based competency self-assessment survey.

RESULTS

Survey response rates in Nova Scotia and Nunavut were 11% (160 responses) and 20% (22 responses), respectively. Comparisons of the estimated number of seniors likely to need each service with the number who can be served by the workforces in each jurisdiction indicated that the workforces in both jurisdictions are sufficiently numerous, active, productive, and competent to provide most of the services likely to be required. However, significant gaps were identified in pharmacy services, ongoing client assessment, client/family education and involvement, and client/family functional and social supports.

CONCLUSION

Service-based HHR planning is feasible for identifying gaps in services required by older adults, and can guide policy makers in planning hiring/recruitment, professional development, and provider education curricula. Implementation will require commitment of policy makers and other stakeholders, as well as ongoing evaluation of its effectiveness. More broadly, the ongoing effectiveness of the approach will depend on workforce planning being conducted in an iterative way, driven by regular reevaluation of population health needs and HHR effectiveness.

A system dynamics model for simulating ambulatory health care demands

INTRODUCTION

This article demonstrates the utility of the system dynamics approach to model and simulate U.S. demand for ambulatory health care service both for the general population and for specific cohort subpopulations over the 5-year period, from 2003 to 2008. A system dynamics approach that is shown to meaningfully project demand for services has implications for health resource planning and for generating knowledge that is critical to assessing interventions.

METHODS

The study uses a cohort-component method in combination with structural modeling to simulate ambulatory health care utilization. Data are drawn from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey.

RESULTS

The simulation of the total population requiring ambulatory services between 2003 and 2008 is performed to test the functionality and validate the model. Results show a close agreement between the simulated and actual data; the percent error between the two is relatively low, 1.5% on average. In addition, simulations of purposively selected population subsets are executed (men, 18-24 years of age, white, African American, Hispanic, and insurance coverage), resulting in error between simulated and actual data, which is 7.05% on average.

CONCLUSIONS

The proposed model demonstrates that it is possible to represent and mimic, with reasonable accuracy, the demand for health care services by the total ambulatory population and the demand by selected population subsets. This model and its simulation demonstrate how these techniques can be used to identify disparities among population subsets and a vehicle to test the impact of health care interventions on ambulatory utilization. A system dynamics approach may be a useful tool for policy and strategic planners.

Ten years of health workforce planning in the Netherlands: a tentative evaluation of GP planning as an example

INTRODUCTION

In many countries, health-care labour markets are constantly being challenged by an alternation of shortage and oversupply. Avoiding these cyclic variations is a major challenge. In the Netherlands, a workforce planning model has been used in health care for ten years.

CASE DESCRIPTION

Since 1970, the Dutch government has explored different approaches to determine the inflow in medical schools. In 2000, a simulation model for health workforce planning was developed to estimate the required and available capacity of health professionals in the Netherlands. In this paper, this model is explained, using the Dutch general practitioners as an example. After the different steps in the model are clarified, it is shown how elements can be added to arrive at different versions of the model, or 'scenarios'. A comparison is made of the results of different scenarios for different years. In addition, the subsequent stakeholder decision-making process is considered.

DISCUSSION AND EVALUATION

Discussion of this paper shows that workforce planning in the Netherlands is a complex modelling task, which is sensitive to different developments influencing the balance between supply and demand. It seems plausible that workforce planning has resulted in a balance between supply and demand of general practitioners. Still, it remains important that the modelling process is accepted by the different stakeholders. Besides calculating the balance between supply and demand, there needs to be an agreement between the stakeholders to implement the advised training inflow.The Dutch simulation model was evaluated using six criteria to be met by models suitable for policy objectives. This model meets these criteria, as it is a comprehensive and parsimonious model that can include all relevant factors.

CONCLUSION

Over the last decade, health workforce planning in the Netherlands has become an accepted instrument for calculating the required supply of health professionals on a regular basis. One of the strengths of the Dutch model is that it can be used for different types of medical and allied health professionals. A weakness is that the model is not yet fully capable of including substitutions between different medical professions to plan from a skill-mix perspective. Several improvements remain possible.

A model to estimate human resource needs for the treatment of outpatients with cancer

PURPOSE

Although personnel costs significantly affect cancer health care expenditures, little is known about the relationship between workload, human resource requirements, and associated costs. An empirical model to forecast staffing demand is described according to the yearly caseload of outpatients with cancer beginning active treatment and the number of personnel working hours.

METHODS

The oncology department at the University Hospital of Udine (Udine, Italy) is a computerized unit taking care of approximately 1,300 patients per year. Each clinical episode is centrally recorded. We queried the database for the total number of consultations per patient beginning treatment during 2006. With predefined bonds (ie, time limit set for each visit type and annual working hours per employee), we sought to estimate yearly per-patient hours of care and the number of personnel needed.

RESULTS

In 2006, each outpatient with cancer beginning active treatment generated an average of 16 clinical evaluations, which in turn translated into 8 and 16 hours of physician and nurse working time, respectively. Assuming an average of 1,672 annual working hours, a need for one physician and three nurses for every 600 patients could be estimated for every 200 novel patients. In the next year, the same caseload induced 4.5 consultations on average; using a similar approach, the demand for additional time and resources was calculated.

CONCLUSION

By means of a simple model combining predefined conditions with a centralized record of clinical episodes, we were able to provide a reasonable estimate of human resource requirements and a tool to forecast the staff expenditures of a cancer unit.

Nurse forecasting in Europe (RN4CAST): Rationale, design and methodology

BACKGROUND

Current human resources planning models in nursing are unreliable and ineffective as they consider volumes, but ignore effects on quality in patient care. The project RN4CAST aims innovative forecasting methods by addressing not only volumes, but quality of nursing staff as well as quality of patient care.

METHODS/DESIGN

A multi-country, multilevel cross-sectional design is used to obtain important unmeasured factors in forecasting models including how features of hospital work environments impact on nurse recruitment, retention and patient outcomes. In each of the 12 participating European countries, at least 30 general acute hospitals were sampled. Data are gathered via four data sources (nurse, patient and organizational surveys and via routinely collected hospital discharge data). All staff nurses of a random selection of medical and surgical units (at least 2 per hospital) were surveyed. The nurse survey has the purpose to measure the experiences of nurses on their job (e.g. job satisfaction, burnout) as well as to allow the creation of aggregated hospital level measures of staffing and working conditions. The patient survey is organized in a sub-sample of countries and hospitals using a one-day census approach to measure the patient experiences with medical and nursing care. In addition to conducting a patient survey, hospital discharge abstract datasets will be used to calculate additional patient outcomes like in-hospital mortality and failure-to-rescue. Via the organizational survey, information about the organizational profile (e.g. bed size, types of technology available, teaching status) is collected to control the analyses for institutional differences.This information will be linked via common identifiers and the relationships between different aspects of the nursing work environment and patient and nurse outcomes will be studied by using multilevel regression type analyses. These results will be used to simulate the impact of changing different aspects of the nursing work environment on quality of care and satisfaction of the nursing workforce.

DISCUSSION

RN4CAST is one of the largest nurse workforce studies ever conducted in Europe, will add to accuracy of forecasting models and generate new approaches to more effective management of nursing resources in Europe.

General practitioner workforce planning: assessment of four policy directions

Background

Estimating the supply of GPs into the future is important in forecasting shortages. The lengthy training process for medicine means that adjusting supply to meet demand in a timely fashion is problematic. This study uses Ireland as a case study to determine the future demand and supply of GPs and to assess the potential impact of several possible interventions to address future shortages.

Methods

Demand was estimated by applying GP visit rates by age and sex to national population projections. Supply was modelled using a range of parameters derived from two national surveys of GPs. A stochastic modelling approach was adopted to determine the probable future supply of GPs. Four policy interventions were tested: increasing vocational training places; recruiting GPs from abroad; incentivising later retirement; increasing nurse substitution to enable practice nurses to deliver more services.

Results

Relative to most other European countries, Ireland has few GPs per capita. Ireland has an ageing population and demand is estimated to increase by 19% by 2021. Without intervention, the supply of GPs will be 5.7% less than required in 2021. Increasing training places will enable supply to meet demand but only after 2019. Recruiting GPs from overseas will enable supply to meet demand continuously if the number recruited is approximately 0.8 per cent of the current workforce per annum. Later retirement has only a short-term impact. Nurse substitution can enable supply to meet demand but only if large numbers of practice nurses are recruited and allowed to deliver a wide range of GP services.

Conclusions

A significant shortfall in GP supply is predicted for Ireland unless recruitment is increased. The shortfall will have numerous knock-on effects including price increases, longer waiting lists and an increased burden on hospitals. Increasing training places will not provide an adequate response to future shortages. Foreign recruitment has ethical considerations but may provide a rapid and effective response. Increased nurse substitution appears to offer the best long-term prospects of addressing GP shortages and presents the opportunity to reshape general practice to meet the demands of the future.

Shaping an Australian nursing and midwifery specialty framework for workforce regulation: criteria development

One of the biggest obstacles identified in achieving Millennium Development Goals (MDGs) was the lack of available qualified health personal to meet the health needs of the global population. With nurses being the main workforce component in health systems, the human resource challenge for most countries is to address the reported shortage of nurses. Skill mix is one suggestion. In Australia, workforce projections indicated a shortage of 40,000 nurses by 2010. Toward the reform of the Australian health workforce, one project aimed to develop a nationally consistent framework for nursing and midwifery specialization based on knowledge and skills to generate the first national database iteration for designated specialties. A literature review looked at the way nursing specialty practices were defined in the United Kingdom, the United States of America and Canada. Three international and three national sources of criteria for specialty nursing practice were mapped against each other. The result was six criteria synthesized to define nursing practice groups as Australian nursing specialties. Each criterion was operationalized with criteria indicators to meet Australian expectations. The nurses in Australia commented on the criteria before they were finalized. An audit of national workforce databases identified nursing practice groups. The criteria were applied to identify nursing specialties and practice strands that would form a national nursing framework. This paper reports on the criteria developed to assess specialty practice at a national level in Australia.

Predictive validity of the International Hospital Outcomes Study questionnaire: an RN4CAST pilot study

PURPOSE

To study the predictive validity of the instrument used in the International Hospital Outcomes Study (IHOS) for an upcoming EU-funded project (RN4CAST), which will indicate the effect of the nursing work environment and nursing staff deployment on nurse recruitment, retention, and productivity; and on patient outcomes in 11 European countries.

METHODS

Cross-sectional analysis of data from 179 nurses (75% response rate) who completed an IHOS-like nurse survey questionnaire, which included the Revised Nursing Work Index and the Maslach Burnout Inventory. The nurses worked in four Belgian acute-care hospitals. Logistic regression modeling was performed to explore associations between nurse-perceived outcomes and nursing work environment factors that were checked with confirmatory factor analysis.

FINDINGS

We confirmed associations between nurse-perceived outcomes and the following nursing work environment factors: nurse-physician relationship; staffing, and resource adequacy; and nurse manager ability, leadership, and support of nurses. A 1-point increase in the rating of the factor nurse-physician relationship was significantly associated with a 2.5-fold (OR, 2.53; 95%CI, 1.29-4.93; p<0.01) increase in the odds of reporting high job satisfaction and with a fourfold (OR, 4.02; 95%CI, 1.85-8.70; p<0.001) increase in the odds of reporting excellent nurse-perceived quality of care. A 1-point increase in the rating of the factor staffing and resource adequacy was significantly associated with an approximate threefold (OR, 2.81; 95%CI, 1.38-5.72; p<0.01) increase in the odds of reporting high job satisfaction and with a fourfold (OR, 0.23; 95%CI, 0.12-0.47; p<0.001) decrease in the odds of reporting burnout.

CONCLUSIONS

The predictive validity of the IHOS instrument was supported by the confirmation of key factors, which were previously identified by previous international research, and by the finding of similar associations between these factors and nurse-perceived outcomes. The IHOS questionnaire that will be used in the RN4CAST project is robust and psychometrically sound.

CLINICAL RELEVANCE

The RN4CAST consortium, consisting of members from 15 countries, will use a similar instrument to that used in the International Hospital Outcomes study to measure the nursing work environment. This information will be linked with patients' experiences and data extracted from routinely collected hospital discharge data. RN4CAST will show the important role of nursing staff in providing high quality care and allow refinement of current forecasting models for personnel planning in nursing.

On evaluating the impact of flexibility enhancing strategies on the performance of nurse schedules

Hospitals develop nurse schedules that cover a period of 4–6 weeks and are posted several weeks in advance. Once posted, changes to the schedule require voluntary participation by the nurses, making it difficult for hospitals to respond to changes in nursing needs and availability of nurses. At the same time, nursing needs’ forecasts developed several weeks in advance are often wrong. In each hospital setting, there may exist several promising strategies to enhance scheduling flexibility and reduce the mismatch between the nursing needs and the availability of nurses. However, methodologies to evaluate such strategies, before testing them in expensive pilot implementation, do not exist. We demonstrate how such evaluations can be carried out using historical data. Furthermore, we demonstrate the use of our approach by evaluating the benefits of a strategy where nurses are divided into two cohorts and schedules are phase shifted for the two cohorts. Staggering schedules allows nursing unit managers to benefit from more frequent updating of needs’ assessments without having to change work rules. Upon applying our approach to data from a large urban hospital, we discovered that in this example staggering did not improve the performance of nurse schedules. We discuss possible reasons for this result, its implications for hospital managers, and other potential uses of our approach.

Population ageing in Sweden: the effect of change in educational composition on the future number of older people suffering severe ill-health

We investigate how expected changes in the educational level composition of the older population may affect future prevalence of severe ill-health among older people in Sweden. Previous research has indicated that the number of older people, given educational differentials in mortality and expected changes in educational composition during the next decades, may increase more than expected following official population projections in Sweden. Eight alternative scenario projections for the possible development in the number of people with severe ill-health in Sweden between 2000 and 2035 are presented. Scenario projections, where both morbidity and mortality inequalities by educational level are taken into account, are compared with scenarios in which only age and gender are modelled. The projections are made with both constant and decreasing mortality. The calculations show that the expected increases in severe ill-health as a result from the ageing of the population in the period 2000-2035 might, to a large extent, be counteracted by the increase in the educational level of the Swedish population. We recommend therefore that in projections of the prevalence of ill-health, in addition to the ageing of the population, also changes in educational level should be taken into account.

Issues facing the future health care workforce: the importance of demand modelling

This article examines issues facing the future health care workforce in Australia in light of factors such as population ageing. It has been argued that population ageing in Australia is affecting the supply of health care professionals as the health workforce ages and at the same time increasing the demand for health care services and the health care workforce.However, the picture is not that simple. The health workforce market in Australia is influenced by a wide range of factors; on the demand side by increasing levels of income and wealth, emergence of new technologies, changing disease profiles, changing public health priorities and a focus on the prevention of chronic disease. While a strong correlation is observed between age and use of health care services (and thus health care workforce), this is mediated through illness, as typified by the consistent finding of higher health care costs in the months preceding death.On the supply side, the health workforce is highly influenced by policy drivers; both national policies (eg funded education and training places) and local policies (eg work place-based retention policies). Population ageing and ageing of the health workforce is not a dominant influence. In recent years, the Australian health care workforce has grown in excess of overall workforce growth, despite an ageing health workforce. We also note that current levels of workforce supply compare favourably with many OECD countries. The future of the health workforce will be shaped by a number of complex interacting factors.Market failure, a key feature of the market for health care services which is also observed in the health care labour market - means that imbalances between demand and supply can develop and persist, and suggests a role for health workforce planning to improve efficiency in the health services sector. Current approaches to health workforce planning, especially on the demand side, tend to be highly simplistic. These include historical allocation methods, such as the personnel-to-population ratios which are essentially circular in their rationale rather than evidence-based. This article highlights the importance of evidence-based demand modelling for those seeking to plan for the future Australian health care workforce. A model based on population health status and best practice protocols for health care is briefly outlined.

Strategic planning in a highly specialized orthopaedic institution

INTRODUCTION

The Institute for Orthopaedic Surgery "Banjica" in Belgrade provides tertiary healthcare services on national level. After decades of constant development, a recent decline coincided with the decade of great social and governmental disturbance, the transition period after the dissociation of former Yugoslavia.

OBJECTIVE

In order to overcome the crisis, we used modern management methods to define problems in the institution management, and to propose appropriate strategies.

METHODS

A survey that included 100 employees (17.67%) was carried out, followed by descriptive statistical analysis, PEST and SWOT analyses.

RESULTS

The impact of political fluctuations, ageing of population, financing model, obsolete medical technology was evaluated. Various personal and interpersonal factors were assessed: the quality of medical service (3.59 +/- 0.76, mark 1-5); relations among health service participants (3.39 +/- 0.78); occupational conditions (not good-91%); human, financial and other resources; professional cooperation, stimulation; rivalry and mobbing (declared in 56%); public informing, institution image (rank 3.70 +/- 0.88) and PR activities (new to 78%). 93% declared to give maximum effort at work.

CONCLUSION

Using these results, we defined several strategic objectives. These include strengthening scientific activities, general orientation to specific and exclusive pathological conditions and treatment methods, improvement of management transparency, introduction of quality-based stimulation of workers, support of promotional and PR activities.