From problem structuring to optimization: a multi-methodological framework to assist the planning of medical training

Medical training is an intricate and long process, which is compulsory to medical practice and often lasts up to twelve years for some specialties. Health stakeholders recognise that an adequate planning is crucial for health systems to deliver necessary care services. However, proper planning needs to account for complexity related with the setting of medical school vacancies and of residency programs, which are highly influenced by multiple stakeholders with diverse perspectives and views, as well as by the specificities of medical training. Aiming at building comprehensive models with a potential to assist health decision-makers, this article develops a multi-methodological framework to assist the planning of medical training under such a complex environment. It combines the structuring of the objectives and specificities of the medical training problem with a Soft Systems Methodology through the CATWOE (Customer, Actor, Transformation, Weltanschauung, Owner, Environment) approach, and the formulation of a Mixed Integer Linear Programming model that considers all relevant aspects. Considering the specificities of countries based on a National Health Service structure, a multi-objective planning model emerges, informing on how many vacancies should be opened/closed per year in medical schools and in each specialty. This model aims at (i) minimizing imbalances between medical demand and supply; (ii) minimizing costs; and (iii) maximizing equity across medical specialties. A case study in Portugal is explored so as to illustrate the applicability of the proposed multi-methodology, showing the relevance of proper structuring for planning models having the potential to inform health decision-makers and planners in practice.info:eu-repo/semantics/acceptedVersio

Implications and possible responses to the effects of staffing moratoria on organisational performance at Ngwelezana tertiary hospital in KwaZulu-Natal.

Doctoral Degree. University of KwaZulu-Natal, Durban.The government is committed to improving the health system by providing universal coverage to all South Africans as articulated in national health policies. The biggest threats facing the health sector today are the shortage of well-trained healthcare workers, the increasing costs and demand for healthcare services. The global crisis of 2008/2009 forced the government to implement cost-cutting measures to reduce public expenditure and resolve budgetary pressures, including in the health sector. The study aimed to examine the implications and possible responses to staffing moratoria, implemented as an austerity measure, on the organisational performance of a public hospital – Ngwelezana Tertiary Hospital in KwaZulu-Natal. The objectives of the study were to examine the impact of staffing moratoria on healthcare service delivery; assess the working conditions and the challenges faced by healthcare workers; and discuss the effect of task-shifting on healthcare service delivery at the hospital. The study employed a mixed-method design in order to yield both quantitative and qualitative data. The quantitative approach was dominant in this study, where a sequential embedded mixed method design was adopted as the most appropriate cross-sectional survey method. The survey yielded a total of 177 respondents. The qualitative approach provided rich information on the perceptions of nine [9] key informants who were interviewed regarding staffing moratoria. Quantitative data was analysed using descriptive statistics, Chi-square tests of association and the Cramer’s V test whilst qualitative data was analysed using thematic analysis. The results show that staffing moratoria at Ngwelezana Hospital resulted in severe staff shortages and the deterioration of working conditions as a result of excessive working hours, job enlargement, limited personal development opportunities, increased administrative and housekeeping burdens on professionals, employee burnout and stress. It also promoted distrust between employees and management that furthered job dissatisfaction at the workplace. Whilst task-shifting was adopted to address staff shortages, delays in serving patients, long waiting periods for patients, increased risks of error and patient mortality was observed. Task-shifting presented its own challenges such as legal and professional risks and staff morale issues. The study proposed a framework that empowers hospitals to implement staffing moratoria based on the supply and demand of labour in order to manage staffing budgets. The study, recommends that staffing moratoria should be supported by a decentralised multi-dimensional approach in planning and implementation to ensure a collective consultative process that involves all relevant stakeholders

Improving Manpower Planning in Health Care

In many countries manpower problems in the field of health care are regular items on the agenda of policy makers. To avoid mismatches between demand of care and supply of care on national and regional levels, manpower planning models and methods are used to determine adequate numbers of medical specialists to fulfil the future demand of care. A key question is which factors should be included in long term (25 years) forecasting and how these factors should be included in a planning model and method. In this paper we evaluate the model and the method for medical manpower planning that has been used since 2000 in the Netherlands. To improve accuracy and relevance of the model, we conclude that system dynamics modelling should be used and that strict distinction should be made between factors influencing the demand for care and factors influencing the supply of care

Improving manpower planning in health care

In many countries manpower problems in the field of health care are regular items on the agenda of policy makers. To avoid mismatches between demand of care and supply of care on national and regional levels, manpower planning models and methods are used to determine adequate numbers of medical specialists to fulfil the future demand of care. A key question is which factors should be included in long term (25 years) forecasting and how these factors should be included in a planning model and method. In this paper we evaluate the model and the method for medical manpower planning that has been used since 2000 in the Netherlands. To improve accuracy and relevance of the model, we conclude that system dynamics modelling should be used and that strict distinction should be made between factors influencing the demand for care and factors influencing the supply of care