Health human resources planning and the production of health: Development of an extended analytical framework for needs-based health human resources planning.

Traditional approaches to health human resources planning emphasize the role of demographic change on the needs for health human resources. Conceptual frameworks have been presented that recognize the limited role of demographic change and the broader determinants of health human resource requirements. Nevertheless, practical applications of health human resources planning continue to base plans on the size and demographic mix of the population applied to simple population-provider or population-utilization ratios. In this paper an analytical framework is developed based on the production of health care services and the multiple determinants of health human resource requirements. In this framework attention is focused on estimating the ‘flow’ of services required to meet the needs of the population that is then translated into the required ‘stock’ of providers to deliver this ‘flow’ of services. The requirements for human resources in the future is shown to depend on four elements: the size and demographic mix of the population (demography), the levels of risks to health and morbidity in the population (epidemiology), the services deemed appropriate to address the levels of risks to health and morbidity (standards of care), and the rate of service delivery by providers (productivity). Application of the framework is illustrated using hypothetical scenarios.health human resources planning, demography, epidemiology, standards of care, productivity

Identification of recruitment and retention strategies for rehabilitation professionals in Ontario, Canada: results from expert panels

<p>Abstract</p> <p>Background</p> <p>Demand for rehabilitation services is expected to increase due to factors such as an aging population, workforce pressures, rise in chronic and complex multi-system disorders, advances in technology, and changes in interprofessional health service delivery models. However, health human resource (HHR) strategies for Canadian rehabilitation professionals are lagging behind other professional groups such as physicians and nurses. The objectives of this study were: 1) to identify recruitment and retention strategies of rehabilitation professionals including occupational therapists, physical therapists and speech language pathologists from the literature; and 2) to investigate both the importance and feasibility of the identified strategies using expert panels amongst HHR and education experts.</p> <p>Methods</p> <p>A review of the literature was conducted to identify recruitment and retention strategies for rehabilitation professionals. Two expert panels, one on <it>Recruitment and Retention </it>and the other on <it>Education </it>were convened to determine the importance and feasibility of the identified strategies. A modified-delphi process was used to gain consensus and to rate the identified strategies along these two dimensions.</p> <p>Results</p> <p>A total of 34 strategies were identified by the <it>Recruitment and Retention </it>and <it>Education </it>expert panels as being important and feasible for the development of a HHR plan for recruitment and retention of rehabilitation professionals. Seven were categorized under the <it>Quality of Worklife and Work Environment </it>theme, another seven in <it>Financial Incentives and Marketing</it>, two in <it>Workload and Skill Mix</it>, thirteen in <it>Professional Development </it>and five in <it>Education and Training</it>.</p> <p>Conclusion</p> <p>Based on the results from the expert panels, the three major areas of focus for HHR planning in the rehabilitation sector should include strategies addressing <it>Quality of Worklife and Work Environment</it>, <it>Financial Incentives and Marketing </it>and <it>Professional Development</it>.</p

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

Contains fulltext : 97171.pdf (postprint version ) (Open Access)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

Planning for what? Challenging the assumptions of health human resources planning

Objectives: Health human resource planning has traditionally been based on simple models of demographic changes applied to observed levels of service utilization or provider supply. No consideration has been given to the implications of changing levels of need within populations over time. Recently, needs based resource planning models have been suggested that incorporate changes in needs for care explicitly as a determinant of health care needs. Methods: In this paper, population indicators of morbidity, mortality and self-assessed health are analyzed to determine if health care needs have changed across birth cohorts in Canada from 1994 to 2005 among older age groups. Multivariate regression analysis was used to estimate the age pattern of health by birth year with interaction terms included to examine whether the association of age with health was conditional on the birth year. Results: Results indicate that while the probability of mortality, mobility problems and pain rises with age, the rate of change is greater for those born earlier. The probability of self-assessed poor health increases with age but the rate of change with age is constant across birth years. Conclusions: Even in the short time period covered, our analysis shows that health care needs by age are changing over time in Canada

Nursing Inputs and Outcomes of Hospital Care: An Empirical Analysis of Ontario's Acute-Care Hospitals

The authors analyze the association between intensity of nursing care (as measured by nursing hours per patient day), hospital bed days, and patient outcomes in acute-care hospitals in the province of Ontario, Canada, to determine whether higher levels of nursing inputs are associated with shorter lengths of stay (LOS) and, if so, whether these shorter LOS are achieved at the expense of health outcomes. After controlling for supply of nurses, workload, community characteristics, and hospital type, the authors found that nursing hours per patient day had a significant negative effect on LOS but had no significant effect on patient satisfaction, hospital mortality, or readmission rates. Further, there was no evidence that shorter than expected LOS were associated with poorer patient health. Such information is relevant for efforts to deploy efficient mixes of health-care resources and to identify future human resource requirements to support the efficient provision of health human resources

Planning for what? Challenging the assumptions of health human resources planning

Objectives Health human resource planning has traditionally been based on simple models of demographic changes applied to observed levels of service utilization or provider supply. No consideration has been given to the implications of changing levels of need within populations over time. Recently, needs based resource planning models have been suggested that incorporate changes in needs for care explicitly as a determinant of health care needs.Methods In this paper, population indicators of morbidity, mortality and self-assessed health are analyzed to determine if health care needs have changed across birth cohorts in Canada from 1994 to 2005 among older age groups. Multivariate regression analysis was used to estimate the age pattern of health by birth year with interaction terms included to examine whether the association of age with health was conditional on the birth year.Results Results indicate that while the probability of mortality, mobility problems and pain rises with age, the rate of change is greater for those born earlier. The probability of self-assessed poor health increases with age but the rate of change with age is constant across birth years.Conclusions Even in the short time period covered, our analysis shows that health care needs by age are changing over time in Canada.Needs based planning Age Cohort and health

Nursing Requirements for Ontario Over the Next Twenty Years: Development and Application of Estimation Methods

In this study we develop, appraise and compare alternative approaches to addressing the problem of determining the quantity and mix of nursing resources required for the health- care system in Ontario in the future. We argue that there is no ‘right’ number of nurses per se. On the contrary, the appropriate number of nurses is conditional upon society’s decisions about the right amount of health-care services to produce - decisions which are essentially political. A critical appraisal of the literature notes that existing research on nursing human resource planning has generally overlooked the political context of the issue (Section 2). Most studies focus attention exclusively on issues of the future supply of nurses and nursing hours. Some studies relate estimates of future supplies to assessments of the future need for nurses. However in these studies assessments of need have been based on adjusting or projecting current levels of provision in accordance with expected demographic changes in the populations being served (the utilization-based approach), or quantifying the resource requirements to meet the estimated burden of illness in the population (the needs-based approach). In some instances authors recognize that planning for future resources is largely determined by what governments decide to allocate to these resources. But this is usually dealt with in the studies by costing the utilization or needs-based requirements and noting that these requirements are likely to be in excess of even the most optimistic estimates of what governments might allocate to nursing resources (i.e., effective demand). In developing the alternative approaches for thinking about the future requirements for nurses a distinction is made between the conceptual basis of the model (i.e., the nature of the question being addressed) and the methodological approach used to apply the model (i.e., the nature of the data requirements) (Section 3). The utilization-based approach is essentially concerned with calculating the numbers of nurses required to serve the estimated future population in the same ways that the current population is served. The needs-based approach bases calculations of requirements on meeting the service needs of the estimated future population in cost-effective ways. The effective-demand-based approach calculates the number of nurses required by the health-care system within the context of current and future resource constraints. Although each approach requires different types of data, these requirements can be addressed by using existing values of the respective variables (i.e., projections), estimating future values of those variables based on exogenous changes (i.e., forecasts) or estimating future values of the variables based on exogenous and endogenous changes (i.e., plans). The applications of the alternative approaches are limited by the availability of appropriate data (Sections 4-6). However illustrative calculations are performed for the utilization and effective-demand based approaches and the sensitivity of the estimates to different assumptions is illustrated. In the case of the needs-based approach, the absence of any appropriate data prevented the illustration of the approach. In other studies, the absence of such information has lead to other types of data, in particular data on nurse vacancies, being used as an indicator of unmet need. Although corresponding data for Ontario are presented here (Section 5), these are not used to calculate future requirements because the determinants of these vacancy data have little, if anything, to do with needs. In summary, the resources required for an ongoing exercise in nurse human resources planning, in terms of the research skills and analytical techniques, already exist. But major issues remain about the willingness and/or ability of those agencies involved directly with issues of nurse human resources to invest in both the collection and management of appropriate data and the further development of analytical techniques.

An applied simulation model for estimating the supply of and requirements for registered nurses based on population health needs

Aging populations, limited budgets, changing public expectations, new technologies, and the emergence of new diseases create challenges for health care systems as ways to meet needs and protect, promote, and restore health are considered. Traditional planning methods for the professionals required to provide these services have given little consideration to changes in the needs of the populations they serve or to changes in the amount/types of services offered and the way they are delivered. In the absence of dynamic planning models that simulate alternative policies and test policy mixes for their relative effectiveness, planners have tended to rely on projecting prevailing or arbitrarily determined target provider-population ratios. A simulation model has been developed that addresses each of these shortcomings by simultaneously estimating the supply of and requirements for registered nurses based on the identification and interaction of the determinants. The model's use is illustrated using data for Nova Scotia, Canada. © The Author(s) 2009