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

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

Eliminating the shortage of registered nurses in Canada:an exercise in applied needs-based planning

Objective: To demonstrate the application of a needs-based framework for health human resources (HHR) planning to illustrate the potential effects of policies on the shortage of Registered Nurses (RNs) in Canada. Methods: A simulation model was developed to simultaneously estimate the supply of and requirements for RNs based on data on the health needs of Canadians with current service delivery patterns and levels of productivity as a baseline scenario. The potential individual and cumulative effects of various policy scenarios on the 'gap' between these were simulated. Results: A baseline scenario estimated a shortage of about 11,000 RN FTEs in 2007 for Canada, increasing to over 60,000 by 2022. However, multifaceted approaches have the potential to eliminate the estimated shortage. Conclusions: Estimating the requirements for health human resources must explicitly consider population health needs, levels of service delivery and HHR productivity while changing supply to meet requirements involves consideration of a broad range of comprehensive interventions. Investments in improved data collection and planning tools are needed to support more effective HHR planning. The estimated Canadian shortage of RNs based on current circumstances can be resolved in the short to medium tern through modest improvements in RN retention, activity and productivity

Human resources planning and the production of health: A needs-based analytical framework

Traditional approaches to health human resources planning emphasize the effects of demographic change on the needs for health human resources. Planning requirements are largely based on the size and demographic mix of the population applied to simple population-provider or population-utilization ratios. We develop an extended analytical framework based on the production of health-care services and the multiple determinants of health human resource requirements. The requirements for human resources are shown to depend on four separate elements: demography, epidemiology, standards of care, and provider productivity. The application of the framework is illustrated using hypothetical scenarios for the population of the combined provinces of Atlantic Canada