Health care is a hands-on business.
Nothing is more important than the workers who provide care to patients who are sick, wounded, scared, dying.
About 1.5 million people work in Canada’s health sector. Seventy per cent of all direct health-care costs go to labour – meaning more than $150-billion a year.
Yet, we put surprisingly little thought into ensuring that we have the right workers in the right place to deliver the care we need.
Sure, we rigorously train health professionals. But we have no global work force planning to speak of – just constant refrains that we need “more, more, more.”
Why do we have the numbers of doctors (89,911 in 2018) and nurses (431,769) that we do?
Why do we have the mix of nurses – nurse practitioners (NPs), registered nurses (RNs), licensed practical nurses (LPNs), registered psychiatric nurses (RPNs) – that we do?
Why do we have more specialists than family doctors and the mix of specialists that we do? For example, despite our aging society, the number of pediatricians is increasing while the number of geriatricians is flat.
Why do we have more physiotherapists than occupational therapists? Why do we have so few midwives (1,690) and physician assistants (500)?
Most of these work force decisions (and non-decisions) are based on historical practices or labour negotiations. We talk constantly of labour shortages and not enough about maldistribution of the workers we have.
In many cases, we don’t even have basic information. Personal support workers (PSWs) are essential in home care and long-term care, but we don’t even know how many there are in Canada, let alone how they blend into health-care teams, or if they work efficiently.
“We do a very poor job of health work force planning in Canada, in large part because of inadequate health work force data,” according to an article published earlier this week in the Canadian Medical Association Journal.
The paper, by researchers at the University of Ottawa’s Telfer School of Management, says that there is an agency, BuildForce Canada, that ensures there is an adequate work force in the construction trades but there is no such agency in health care, although that has been recommended repeatedly.
Canada isn’t alone in this neglect.
“No country consistently gets work force planning right,” says Mark Britnell, chairman of the global health practice of consulting firm KPMG International.
In his recent book, Human: Solving the Global work force Crisis in Healthcare, he says that “we are hurtling towards a global crisis.”
Mr. Britnell warns that, within a decade, we will be short about 18 million health workers worldwide – about a 20 per cent shortfall in most professions. In the United States alone, they will be short one million nurses and 105,000 doctors – and they’re going to come and get them from countries such as Canada.
Canada, in turn, will continue its practice of pilfering physicians, nurses, PSWs and others from countries such as South Africa, the Philippines, India and more. Already, one-quarter of our health workers are foreign-trained, and there will be more competition to attract these skilled workers.
In his book, Mr. Britnell says data collection and planning are essential, but we also need to change our mindset.
We have to see the health work force, not just as an expense, but as an economic driver. We also have to focus on productivity rather than raw numbers.
Practically, that means ensuring everyone works to their full scope of practice. Because of rampant turf protection, we don’t do that now.
As team-based care becomes more commonplace, the mix of health workers and how they divvy up tasks, becomes all the more important to productivity. It also requires better management.
Mr. Britnell argues that we need to rethink our traditional approach of strictly controlling the number of health workers we educate and train and turn to oversupply, knowing that many will be wooed away.
We have to put a lot more effort into retaining the health workers we have by keeping them healthy and engaged. One in five nurses in Canada leaves their job each year, and the turnover costs are enormous.
Finally, with all the talk of technological change that is coming – artificial intelligence, genomics, robotics, etc. – we have to train a new cadre of digital health workers for this brave new world.
In short, countries such as Canada have to tackle the cognitive dissonance of their health human resources policies, chief among them proclaiming the importance of health workers and doing nothing to ensure jobs are meaningful, appropriate and, most of all, that there are people to fill the posts that are so essential to our care.
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André Picard