Strategies to overcome human health resource challenges (YEL2022)

Date:  23 September 2022

Strategies to overcome human health resource challenges (YEL2022)

Authors: Iman Al Nadaby (Oman), Olivier Costa (Belgium), Luis Moniz (Portugal), William Roberts (United Kingdom), Maria Rubio Valera (Spain).

Reviewers (YEL Alumni): J. Antônio Cirino (Brazil), Dr Samar Almuntaser (Dubai).

Introduction

For several years, human resources strategies have been a main topic of interest and worry for the global healthcare community (1). Studies have looked at reasons for the difficult job market within the context of healthcare and have proposed actions to address these problems (2).

More recently, the sudden and dramatic dynamics of COVID-19, with accompanying shifts in local and global economic activity, have had a profound impact on job markets in sectors as diverse as construction, transportation, leisure, and consulting. Besides the pressure from supply chains, the pandemic made people reconsider their professional choices and look for new opportunities. For example, almost 57 million Americans quit their job between January 2021 and February 2022 (3).

As a result, many companies in all those different industries sought to understand what drives the changes and what strategies could be deployed to keep the workforce at a sufficient level. Reasons for what is called the “Great Resignation” are found in the fact the pandemic showed a newfound purpose in one’s professional life but also that a certain degree of flexibility (and remote working) could be aimed for.

Nevertheless, other trends, such as an ageing workforce in some economies and a tendency towards higher rates of burnout in white-collar jobs were already in place before the pandemic hit. Higher rates of turnover were also observed in industries with a large percentage of low-wage workers due to gradually worsening conditions in those industries (4).

This article aims to review what happens within and beyond the healthcare ecosystem, and to propose initiatives based on those other experiences.

Methods

At a micro level, health centres are implementing strategies to deal with the lack of appropriately trained and motivated professionals, which are necessary to provide on time, safe, and quality care. According to the literature, strategies can be aimed at

a) reducing the burden of professionals and increasing efficiency;

b) increasing the recruitment and onboarding of healthcare professionals (HCP);

c) improving the engagement and retention of HCP.

A survey was conducted to explore which strategies are being implemented within the members of the IHF. The survey consisted of questions to characterize the respondent and 25 questions with a 5-point Likert-scale to assess initiatives taken by the institutions and their effectivity in a semi-quantitative fashion. Thirty-two hospital leaders and physicians completed it across Europe, Asia, North and South America.

Results

The survey highlighted the severity of the healthcare workforce challenge. Despite the global shortage reaching 15 million by 2030 (5), there was room for optimism.

The use of technology to reduce workload was at least used sometimes amongst 73% of leaders (Fig.1A), but a greater reliance was placed on more traditional quality improvement and productivity programmes, adopted at least sometimes amongst 85% of leaders (Fig.1B).

Figure 1: Frequency distribution of number (percentile) of answers according to a Likert scale 1-5 on (A) Use of new technologies to reduce workload and (B) Implementation of quality improvement programmes to increase the efficiency of care.

Alternative approaches to better manage healthcare demand included the introduction of new professional roles (Fig. 2A) and improved integration across the continuum of care (Fig. 2B), with common approaches including the rotation of health professionals; these strategies appear to be more challenging to implement with just 33% and 36% respectively adopting these either very frequently or always.

Figure 2: Frequency distribution of number (percentile) of answers according to a Likert scale 1-5 on (A) Introduction of new professional roles and (B) Improved integration across the continuum of care.

Approaches to recruitment and onboarding of HCPs proved to be much more varied, perhaps expectedly given the range of healthcare systems our leaders are operating within. The most common strategy was placing emphasis on undergraduate and postgraduate training (Fig.3A), with 85% utilizing such techniques at least sometimes. Despite the narrative around staff recruitment and retention often focused on pay, financial incentives were seldom adopted (Fig. 3B), with nearly half of leaders either rarely or never using such incentives. (Leaders did highlight the use of financial incentives for employees to introduce new employees. Whilst more commonplace in other industries, this approach is more innovative within healthcare.) Given hospitals often act as monopolies within certain geographies and sub-specialisms or as monopsonies in the case of public health systems, this is perhaps unsurprising. Only two of 14 providers with more than 500 beds adopting financial incentives, perhaps given limited competition in their market.

Figure 3: Frequency distribution of number (percentile) of answers according to a Likert scale 1-5 on (A) Undergraduate and/or postgraduate training (B) Financial and economic incentives.

It should be of concern to the IHF there is a reliance on international recruitment programmes. (Fig. 4A) Whilst the 58% of leaders utilizing such programmes at least sometimes appears low, this is skewed away from public health systems, where only 44% (n=18) adopt these international recruitment programmes. The unintended consequence of such programmes on other countries can be significant.

Consistent with recruitment, professional education and development (Fig. 4B) were the most adopted approaches to staff retention, with all but one centre (97%) using education. It appears that leaders place less emphasis on initiatives to engage with staff desires. Examples of those initiatives are periodical stay interviews to highlight improvement opportunities, stress management, reduction in working hours and work from home opportunities.

Figure 4: Frequency distribution of number (percentile) of answers according to a Likert scale 1-5 on (A) Use of international recruitment programmes (B) Professional education and development.

There is clear recognition amongst international healthcare leaders that providing an adequate number of competent and motivated staff is essential. Without these HCPs, we have no healthcare. Innovate approaches are however seldom adopted and leaders recognize that their human resources strategies are limited. Indeed, no health leader assessed their strategy as greater than seven out of ten with most leaders (58%) rating their strategies no greater than five (Fig. 5). Feedback received from leaders indicates long-term investment in education and training should be prioritized. The absence of such investment, alongside challenges to recruit to underserved areas and international migration of HCPs, can result in challenges to universal healthcare access. This view – supported by the WHO – can result in HCP shortage co-existing with major unmet population health needs.

Figure 5: Frequency distribution of number (percentile) of answers according to a Likert scale 1-10 on self-assessment of the Human Resource strategy for recruitment and retention of professionals at the own centre.

Conclusions

The World Health Organization, through the document The Global strategy on human resources for health: Workforce 2030 (1), was clear and objective in its aims: Health systems can only function with health workers; The health workforce will be critical to achieving health and wider development objectives in the next decades; Persistent health workforce (…) require the global community to reappraise the effectiveness of past strategies and adopt a paradigm shift in how to plan, educate, deploy, manage and reward health workers.

Aware of this, what are we doing to enhance the human capital of health? What are the strategies? Moreover, what is the perception of hospital leaders?

The first conclusion is the most positive: It seems that hospital leadership is aware of the relevance of this topic in the context of the challenges that healthcare faces now and in the coming years.

Despite this, it seems that innovation efforts to reduce the workload of professionals and increase efficiency are being made, above all, through the increase in the use of technology, which, while not being bad at all, seems to neglect alternative approaches, perhaps more cost- effective, such as the incorporation of new professional roles and the creation of integrated practice units (6, 7).

Regarding the recruitment and onboarding of HCPs, within a framework of enormous heterogeneity of countries and health systems, of public and private hospitals, we perceive a present concern of hospital leaders with the good recruitment and integration of healthcare professionals, as a scarce resource. More than financial incentives, which are not always available in public hospitals, there is a concern with continuing education and specialization programmes. Within a Plan, recruit, retain (8)  basis, there is the notion that well-targeted recruitment strategies and selection criteria are important in subsequent retention, as the better matched an individual is to a role and organization, the longer they are likely to remain, independently of the effect of additional retention strategies (9).

Still in terms of recruitment, there seems to be a high level of unfamiliarity or inability to access international recruitment, which can be an asset for hospitals and health systems, in addition to a recommendation and strategic objective by the WHO (10).

Last, but not least (for sure!), is the importance of improving the engagement and retention of HCP’s, seen as a strategic goal, given that engaged employees are committed and satisfied with their work and willing to give extra effort to achieve the organization’s goals, benefiting patients and reducing the workforce costs associated with turnover (11). Even more when evidence suggests that engagement influences other major human resources goals, such as retention, job performance and absenteeism (12, 13).

For healthcare leaders, the overall conclusion is that higher levels of employee engagement must become a strategic goal for all healthcare organizations. In addition, reducing the engagement gap must become part of risk management by hospital boards and executive teams.

From the results of this survey, it appears that healthcare leaders place less emphasis on initiatives to engage with staff desires and innovate approaches are seldom adopted. Leaders recognize that their human resources strategies are limited. Moreover, this is, for us, a reason for alert and concern.

In fact, there seems to be no discussion around the importance of achieving a highly engaged workforce in healthcare institutions, directly linked to positive patient experiences and outcomes (14). Staff engagement, defined as improved trust, communication, and satisfaction, is a challenge for health care organizations. Such an environment can lead to a satisfied workforce, which in turn leads to exemplary outcomes in patient care and customer satisfaction (15).

As such, healthcare leaders must adapt and vary their leadership styles, if they hope to effectively engage their teams and provide excellent patient-centred care.

Elsevier’s Clinician of the Future report (16) gave us a terrifying picture of current Health: Burnout: 26% of clinicians surveyed agreed wellbeing support is a priority; Imbalance: Full-time employed clinicians surveyed work 49 hours on average. Only 57% agreed they have a good work–life balance; Depleting joy: Many roles are changing for the worse: 71% of doctors in the USA and 66% in the UK agreed their roles have become worse in the last 10 years.

The perspectives are not also good: Shortages: Clinicians believe there will be a shortage of nurses (74% globally agreed) and doctors (68%). Different roles: 41% of clinicians expect to be seen as less valuable to patients. Digital burden: 69% of clinicians agreed digital health technologies would be a challenging burden.

Because of the situation, in the Clinician of the Future survey, a large part of respondents shared that they were planning to leave their current role within the next two to three years, with higher proportions in Germany (48%), the UK (47%) and the USA (47%). Those leaving the profession may be doing so due to a general feeling of being undervalued and unappreciated.

The driver for change seems to be easy: A robust, motivated workforce is essential for a sustainable functioning healthcare system. Engaged, valued clinicians would be less likely to leave the profession and at lower risk of burnout, especially if they were part of a fully staffed team.

A simple recipe for all healthcare manager’s: Focus on clinician wellbeing. Ensure a complete workforce. Recruit through optimized training. Will we be able to? As members of the International Hospital Federation’s Young Executive Leaders programme, we very much look forward to exchanging thoughts on this topic at the upcoming World Hospital Congress, 9-11 November in Dubai, UAE and beyond in our future endeavours.

References

(1) World Health Organization. Global strategy on human resources for health: Workforce 2030. (Online: https://www.who.int/publications/i/item/9789241511131)

(2) Verma P, Ford JA, et al.A systematic review of strategies to recruit and retain primary care doctors. BMC Health Serv Res 16, 126 (2016).

(3) Ferrazzi K, Clementi M. The Great Resignation Stems from a Great Exploration. Harvard Business Review, online (2022).

(4) Fuller J, Kerr W. The Great Resignation Didn’t Start with the Pandemic. Harvard Business Review, online (2022).

(5) World Health Organization. Health workforce (Online: https://www.who.int/health-topics/health-workforce#tab=tab_1)

(6) S. Department of Health and Human Services. Healthcare provider shortages: resources and strategies for meeting demand. (Online: https://files.asprtracie.hhs.gov/documents/healthcare-workforce-strategies-for-managing-a-surge-in-healthcare-provider-demand.pdf)

(7) Essex Primary Care Workforce Strategy. (Online: https://castlepointandrochfordccg.nhs.uk/about-us/our-governing-body/governing-body-meetings/2017/28-september-2017/2923-item-07a-essex-workforce-strategy-final-280917/file)

(8) Abelsen B, Strasser R, et al. Plan, recruit, retain: a framework for local healthcare organizations to achieve a stable remote rural workforce. Human Resources for Health 18, 63 (2020).

(9) Humphreys J, Wakerman J, et al. Retention strategies & incentives for health workers in rural & remote areas: what works? Australian Primary Health Care Research Institute (2009).

(10) World Health Organization. WHO Global Code of Practice on the International Recruitment of Health Personnel. (Online: https://www.who.int/publications/i/item/who-global-code-of-practice-on-the-international-recruitment-of-health-personnel)

(11) Lowe G. How employee engagement matters for hospital performance. Healthc Q 15(2): 29-39 (2012).

(12) Gibbons J, Schutt R. A Global Barometer for Measuring Employee Engagement. (Research Working Group Report No. 1460-09- RR). New York: Conference Board (2010).

(13) Mannion R, Davies TO et al. Cultural Characteristics of ‘High’ and ‘Low’ Performing Hospitals. Journal of Health Organization and Management 19: 431–39 (2005).

(14) Thibeau A. Engaging the Health Care Professional. Educational Perspective 50(3): 365-368 (2019).

(15) George V, Massey L. Proactive Strategy to Improve Staff Engagement. Nurse Lead 18(6): 532-535 (2020).

(16) Elsevier Health. Clinician of the Future: a 2022 report. (Online: https://www.elsevier.com/connect/clinician-of-the-future)

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