Report on the working conference Health Workforce Managing a Scarce Resource 1

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1 Report on the working conference Health Workforce Managing a Scarce Resource On November the European Health Management Association in cooperation with its Workforce Taskforce members and hosted by Semmelweis Health Services Management Training Centre organised the working conference Health Workforce managing a scarce resource. The working conference was supported by the European Commission s Second Public Health Programme, and discussed the complexities in the recruitment and retention of health workers, the challenges of coordination and cooperation between different stakeholders in the field, and of bringing stakeholders within and across countries together. The two-day participatory programme was introduced by EHMA Director Jeni Bremner who welcomed the participants and outlined some of the current challenges health systems need to meet, and how this reflects in expectations around the health workforce. During the morning session Dr. Gaál, Dean of the Health Services Management Training Centre described how the Management Centre contributed to the field and provided insights in the current state of play in Hungary. The key presentation of the first morning was provided by Ms. Hager, Policy Officer at the European Commission DG SANCO, who outlined the actions of the European Commission in relation to health workforce challenges. Current actions are embedded in a wider European strategy aimed at economic recovery and job creation called the Employment Package. This package shows that health was one of the few areas where a growth in employment opportunities was predicted, with nursing being the occupation where there were currently the most job vacancies in Europe. Within this package, there is a specific strategy for the health workforce the Action Plan for the EU Health Workforce. The Action Plan promotes European cooperation through exchanging practices, supporting European networks, and by supporting research. Activities in the plan address the improvement of workforce planning (in particular through the Joint Action on Health Workforce planning) and improve anticipation of skills needs (through the possible creation of an EU sector skills council). Recruitment and retention, including the mapping and sharing of good practices are a key area as well, with ethical international recruitment i.e. support for the implementation on the WHO Global Code of Practice on ethical recruitment as a complementary domain. Points made in the following discussion questioned the mismatches on the current labour market, and that might emerge in the future. Some Member States see a decrease in the number of vacancies because of the crisis, while other countries or EU Member States have surpluses of certain groups already. The afternoon started with an inspiring session by Miklós Szócska, Minister of State for Health in Hungary. He shared his frontline experiences as a politician and an active contributor to better health workforce policies and forecasting mechanisms and a more sustainable healthcare system in general. He gave a lively personal account of his experiences and actions, 1 P a g e

2 touching on all challenges related to the health workforce including salary negotiations with stakeholders, attempts to address mobility outflows by setting up bilateral agreements and taking action to meet the needs of health workers (e.g. less hierarchical structures within healthcare organisations). This was followed by presentations on retention and recruitment practices. EHMA policy analyst Paul Giepmans outlined aspects of possible retention strategies, and what these might look like. Results from a case study showed that different hospitals with varying needs applied different strategies, ranging from ad-hoc assessments of issues to strategies based on comprehensive, external and internal reflection processes. Overall, the conclusion was that improved retention requires acting on a multiplicity of different aspects of the problem. Management actions need to be supported by wider policy frameworks, and as the meeting s discussion paper showed, policy and management actions show overlap. To use capacity and resources as effectively as possible, stakeholders need to cooperate on an organisational and local/regional level. Ms. Lon Holtzer (Care ambassador for the Flemish government) presented the work being carried out in Flanders to recruit health workers. A positive campaign was launched emphasising the Job satisfaction of by showing that in healthcare you work with your head, hands and heart. The campaign shows the range career opportunities, and she noted that there had been a good response from groups in mid career. Ms Holtzer also emphasized that recruitment and retention discussions often focus on hospital workers and nurses, and most (potential) students are interested in working in hospitals rather than in other health and care related organisations. However homecare and mental healthcare organisations have a high demand for health workers. An important message from the presentation is that we ought to aim to create magnet professions instead of magnet hospitals. Part of the afternoon was spent in group sessions where participants worked on priorities for the health workforce, and, in particular, for recruitment and retention while alternating between peer groups and country groups. Within these groups great levels of complexity were addressed, which were then fed back to the plenary meeting. The following themes came forward: Building more capacity in the system: When addressing health workforce challenges it is important not to lose sight of the central issue of quality patient. There are many mismatches within the system, for instance in the skill mix of health workers and the services healthcare organisations provide. Current structures of health systems find their roots in the 60s and might not be well-equipped to meet future challenges. There is a strong need for more prevention and to shift from hospital to community care and from specialised care to general care the question is how managers can best lead their workforce in times of change? As systems change there is a need to build in more adaptability and flexibility. All this requires increased capacity for education, planning (e.g. through the Joint Action on workforce planning) and management. Addressing the functioning of the labour market for the health workforce: As countries invest in the costly education and training of their health workers, they expect some return on investment. Providing financial incentives for newly trained health workers or having the ability to make 2 P a g e

3 sure they work for a given period of time in the country in which they trained might be options to regulate this. Addressing the need for coordination and collaboration between different stakeholders: Country participants showed a great willingness to focus on starting or improving inter-sectoral collaboration. Better communication and shared decision making is needed to ensure the right number of health workers are trained and not to make costly investments resulting in oversupply. The second day started with a presentation by NIVEL s (Netherlands institute for health services research) programme coordinator for health workforce planning, Ronald Batenburg, on health workforce planning and how policy decisions are informed in the Netherlands. Health workers are essential in guaranteeing accessibility and quality of care and cost-containment in healthcare provision. However, in the context of an ageing workforce, increasing demands from patients and a complex environment with market and regulatory mechanisms the health workforce is under pressure. Consequently, the government, health insurers and providers have a shared responsibility in maintaining a high level health workforce. The Dutch government regulates the inflow in medical schools and specialist training, but not in paramedic and nurse(assistant) training. For physicians, demand and supply analysis result in gap analyses and then in a needs based approach. This is coordinated by one national and independent organization: the Advisory Committee on Medical Manpower Planning (ACMMP). The ACMMP mobilises research to run a simulation and forecasting model and mobilises practice i.e. ensures consensus on the model inputs and scenarios. Dr. Batenburg then took the audience step by step through the forecasting model before discussing how the model is embedded in the wider policy structures. All stakeholders (doctors, training institutes and insurers) are asked to estimate the current shortage/oversupply of health care workers and the future demand for health. This requires not only a vision of what is actual required supply (current unmet demand), but also a vision about system changes and changes in the professions (for example: what will be the effect of specialization, self-employed vs. team-based work, efficiency, the implementation of the European Working Time Directive etc?), Balancing the different needs and possibly conflicting interests is a challenging exercise that requires commitment and consensus from the different stakeholders, and the joint recognition of an independent organisation. The conference continued with smaller group discussions around what is currently known about recruitment/retention and future needs, what needs to be known, and what can be done now and in the near future. The smaller groups (mixed backgrounds and countries) then reported back to the plenary. Reported actions that are necessary to implement the ambitions outlined during the first day included: To improve data and indicators, as well as access to data sets and the products of forecasting exercises. Information on outflow of professionals will need to come from source countries and if an increase in exchange of information and data is needed, then this will require compatibility of data. To increase our understanding on recruitment of health workers and mobility in general, more information on the motivations of health workers to move and their profiles are required. Concerning recruitment, 3 P a g e

4 what can be learnt from commercial companies and their profiling techniques? To stimulate cooperation between stakeholders in the system. There is a need to identify common interests in specific contexts for more stability, and to build platforms for dialogue between the education and healthcare sector about the training of (different groups of) health workers. To build management capacity and make working environments better, there is a need to scope ways of promoting respect of the different health workers roles, to involve them in decision-making, and to discuss the role of doctors/specialists and their tasks (and how this may relate to strengthening the nursing profession). To motivate health workers to move and work in under-served areas. Hungary found that just financial incentives were not successful, and it was reported that support for relocation of the family as well as the individual was a particular lack in the plan. Norway embraced telemedicine as an alternative (technical solution) for some issues. During the closing panel participants gave their views on what they learned and a few were invited to reflect on the discussions of the last 2 days and to extract key messages. Prof. Sermeus started by concluding that the right metrics, the right incentives and the right management and leadership skills are needed in order to prepare for a future in which the healthcare systems will have to do more with less. Ms. Holtzer reiterated that in the end it is about people, patients and quality of care. Culture and language are important for the quality of care, and when discussing health workforce mobility this remains an important point. Lastly, we should not lose supporting staff out of sight as they make significant contributions to social and healthcare delivery. Ms. Hager stated that once more it became clear why the Joint Action on Health Workforce planning is important and timely. Comprehensive analysis should lead to better understanding about what makes policy options failures or successes and the particular country contexts should be included in that analysis. There deserves to be further research on how to build linkages between education and the health system as well as the benefits and costs (cost-effectiveness) of recruitment and retention practices. Next steps EHMA s Health Workforce Taskforce and EHMA staff members will work on an article with the aim to have it published in a popular journal/magazine (December2012/January2013). EHMA will address the strong need for collaboration and coordination through national platforms through the Joint Action on Health Workforce Planning, in which the Association co-leads the dissemination work with Slovakia. In-country experts on health workers will be supported in setting up platforms for planning. As the results of the meeting showed a strong need for capacity building sessions, and given the profile of the European Health Management Association, it is likely that next year will see the organisation of another such session in collaboration with the Workforce Taskforce. 4 P a g e

5 Suggested resources for further learning: European Commission Action Plan for the health workforce. Online available: orkforce_en.pdf Feasibility study on EU level collaboration on forecasting health workforce needs, workforce planning and health workforce trends. Online available: _en.htm RN4Cast website: Paul Giepmans and Gilles Dussault (2012) Discussion paper: Planning and managing a scarce resource: policy and management strategies for the health workforce. Online available: Malou Van Greuningen, Ronald S Batenburg, Lud FJ Van der Velden (2012) Ten years of health workforce planning in the Netherlands: a tentative evaluation of GP planning as an example. Human Resources for Health (online) Ellen Kuhlmann, Ronald Batenburg, Peter P. Groenewegen, Christa Larsen (2012) Managing Health Human Resources in Europe: a scoping review. Health Policy (forthcoming) Paul Giepmans, 03/12/2012 Please send comments or suggestions to Paul.Giepmans@ehma.org The Workforce Taskforce is part of the operating grant EHMA FY2012 which is co-funded by the European Union, in the framework of the Health Programme. Sole responsibility lies with EHMA and the Executive Agency is not responsible for any use that may be made of the information contained therein 5 P a g e