workforce planning in a rapidly changing healthcare system• ehrs used to monitor paent and...
TRANSCRIPT
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WorkforcePlanninginaRapidlyChangingHealthcareSystem
ErinFraher,PhDMPPDirector,CarolinaCenterforHealthWorkforceResearch,
CecilG.ShepsCenterforHealthServicesResearch,AssistantProfessor,DepartmentsofFamilyMedicineandSurgery,
UniversityofNorthCarolinaatChapelHill
SouthCarolinaHealthCareWorkforceForumFebruary13,2017
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Disclaimer/NoConflictofInterest
• MyworkissupportedbytheNa4onalCenterforHealthWorkforceAnalysis(NCHWA),HealthResourcesandServicesAdministra4on(HRSA)undercoopera4veagreement#U81HP26495,TheRobertWoodJohnsonFounda4onandThePhysiciansFounda4on.
• Theinforma4on,conclusionsandopinionsexpressedinthispresenta4onaremineandnoendorsementbythefundersorTheUniversityofNorthCarolinaisintendedorshouldbeinferred.
• Ideclarenoconflictofinterest.
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ThispresentaKoninoneslide
• Currentsystemisnotsustainable—costpressureswilldrivechange
• Increasedemphasisonpopula4onhealthrequiresexpandeddefini4onofhealthworkforce
• Nursingworkforceiscri4caltotransforma4on.NeedtoshiYdialoguefromnumberstoretooling
• Di[oforphysicians—bigissueismaldistribu4onbyspecialtyandgeography
• Workforceplanningforrapidlychanginghealthcaresystemrequiresbe[erconnec4onsbetweeneduca4onandprac4ceandamoreflexibleworkforce
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ForcesDrivingChange
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Whydowecareaboutthehealthworkforce?
• Workforceisexpensive:of$2.6trillionspentonhealthcare,56%a[ributedtowages*
• Expensiveandinefficienttolurchfromoversupplytoshortage
*DunnL.GeWngaHandleonHospitalCosts.HospitalsandHealthNetworks.2015
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Needstrategicworkforceplanningto“smooth”thecycle
time
supp
ly
Typical intervention point
Ideal intervention point
Supply of health professionals
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LetOneThousandFlowersBloom:Experimentstoreformhealthsystem
• Withorwithouthealthreform,costpressuresaredrivingchange
• Newmodelsofcareaimtolowercosts,enhancequality,improvepopula4onhealthandlowerproviderburnout– Pa4entCenteredMedicalHomes
– AccountableCareOrganiza4ons– ClinicallyIntegratedNetworks
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WhatarethekeycharacterisKcsofnewmodelsofcare?
ProvidepaKentswithmorecomprehensive,accessible,coordinatedandhighqualitycareatlowercosts
• Emphasisonprimary,preven4veand“upstream”care
• Careisintegratedbetween:– Primarycare,subspecial4es,homehealthagenciesandnursinghomes
– Healthcaresystemandcommunity-basedsocialservices
• EHRsusedtomonitorpa4entandpopula4onhealth—increaseduseofdataforriskstra4fica4onandhotspofng
• Interven4onsfocusedatbothpa4ent-andpopula4on-level• Movetowardrisk-basedandvalue-basedpaymentmodels(maybe?)
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Differenthealthsystemmeansdifferentworkers
“Atransformedhealthcaresystemwillrequireatransformedworkforce.
ThepeoplewhowillsupporthealthsystemtransformaIonforcommuniIesand
populaIonswillrequiredifferentknowledgeandskills…inprevenIon,carecoordinaIon,careprocessre-engineering,disseminaIonofbestpracIces,team-basedcare,conInuousqualityimprovement,andtheuseofdatatosupporta
transformedsystem.”
Source:CentersforMedicareandMedicaidServices,HealthCareInnovaKonChallengeGrant,FundingOpportunityNumber:CMS-1C1-12-001,CFDA:93.610,November2011.hcp://www.innovaKons.cms.gov/Files/x/Health-Care-InnovaKon-Challenge-Funding-Opportunity-Announcement.pdf
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AHealthWorkforceoraWorkforceforHealth?
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Whoisthrowingbodiesintotheriver?
“IamstandingbytheshoreofaswiYlyflowingriverandhearthecryofadrowningman.Ijumpintothecoldwaters.Ifightagainstthestrongcurrentandforcemywaytothestrugglingman…Ilayhimoutonthebankandrevivehimwithar4ficialrespira4on.Justwhenhebeginstobreathe,Ihearanothercryforhelp…Ifightagainstthestrongcurrent,andswimforcefullytothestrugglingwoman…IliYheroutontothebankbesidethemanandworktoreviveherwithar4ficialrespira4on.Justwhenshebeginstobreathe,Ihearanothercryforhelp….Nearexhaus9on,itoccurstomethatI'msobusyjumpingin,pullingthemtoshore,applyingar9ficialrespira9onthatIhaveno9metoseewhoisupstreampushingthemallin....”(AdaptedfromastorytoldbyIrvingZolaascitedinMcKinlay,JohnB."Acaseforrefocusingupstream:Thepoli4caleconomyofillness."InConradandKern,2ndedi4on,1986,TheSociologyofHealthandIllness:CriIcalPerspecIves.pp.484-498.)
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ThisistheaimofAccountableHealthCommuniKesModelannouncedbyCMS“Werecognizethatkeepingpeoplehealthyisaboutmorethanhappensinsideadoctor’soffice…wearetesIngwhetherscreeningpaIentsforhealth-relatedsocialneedsandconnecIngthemtolocalresourceslikehousingandtransportaIontothedoctorwillulImatelyimprovetheirhealthandreducecoststotaxpayers…”SecretaryBurwell,h[p://www.hhs.gov/about/news/2016/01/05/first-ever-cms-innova4on-center-pilot-project-test-improving-pa4ents-health.html
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AccountableHealthCommuniKesGoalsandAims
“ThefoundaIonofthemodelisuniversal,comprehensivescreeningforhealth-relatedsocial
needs—includinghousingneeds,foodinsecurity,uIlityneeds,interpersonalsafetyandtransportaIon
difficulIes—inallMedicareandMedicaidbeneficiarieswhoobtainhealthcareatparIcipaIngsites”
Alley,DE,AsomughaCN,ConwayPH,SanghaviDM.(2016).AccountableHealthCommuni4es—AssessingSocialNeedsthroughMedicareandMedicaid.NewEnglandJournalofMedicine.371;1:8-11.
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SuchanapproachrequiresbroaderdefiniKonofthehealthworkforce
PopulaKonhealthrequiresusto:
• Expandworkforceplanningeffortstoincludeworkersincommunityandhome-basedsefngs
• Embracetheroleofsocialworkers,pa4entnavigators,communityhealthworkers,homehealthworkers,communityparamedics,die4ciansandothercommunity-basedworkers
• Planforworkforceneedsofpa4entsandcommuni4es,notforneedsofprofessions
• Determinehowtointegratethepublichealthworkforceintohealthworkforceplanning
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Wheredoesthepublichealthworkforcefitin?
• “PublicHealth3.0”(Oct2016)callsfor“neweraofenhancedandbroadenedpublichealthprac4cethatgoesbeyondtradi4onalpublichealthdepartmentfunc4ons”
• Howwillpublichealthmaintaintradi4onalstrengthsandconfrontchallengesofagingpopula4onwithchronicdisease?
• “Health-in-all-policies”arereshapinginterfacebetweenpublichealthandcommunitypartners
• PublicHealth3.0callsfora“ChiefHealthStrategist”todevelopcommunitypartnerships
• Thosepartnersincludehospitalsandphysicianprac4ces
Source:OfficeoftheAssistantSecretaryforHealth,USDepartmentofHealthandHumanServices.ACalltoAcKontoCreatea21stCenturyPublicHealthInfrastructure.Washington,DC.October2016.hcps://www.healthypeople.gov/sites/default/files/Public-Health-3.0-White-Paper.pdf
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IntegraKngpublichealthandhealthworkforceplanning
• RecentsurveybyNa4onalAssocia4onofCountyandCityHealthOfficials(NACCHO)foundthat58%oflocalhealthdepartmentswerecollabora4ngwithhospitalsoncommunityhealthneedsassessments
• ButareCHNAsbeingusedforworkforceplanning?• Surveyiden4fiedskillgapsininforma4cs
• Publichealthworkforceofthefuturewillincreasinglyneedtouse“bigdata”forsurveillance,assessmentandevalua4on(andworkforceplanning!)
Source:NACCHO.2016NaKonalProfileofLocalHealthDepartments.WashingtonDC.hcp://nacchoprofilestudy.org/wp-content/uploads/2017/01/Main-Report-Final.pdf.
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Boundaryspanningrolesgrowingquickly
PanelManagers HealthCoaches
Assumeresponsibilityforpa4entsbetweenvisits.UseEHRsandpa4entregistriestoiden4fyandcontactpa4entswithunmet
careneeds.OYenmedicalassistantsbutcanbenursesor
otherstaff
Improvepa4entknowledgeaboutdiseaseormedica4onandpromotehealthybehaviors.Maybemedicalassistants,nurses,
healtheducators,socialworkers,communityhealthworkers,pharmacistsorotherstaff
“Boundaryspanning”rolesreflectshiYfromvisit-basedtopopula4on-basedstrategies
Twoexamples:
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Othernewrolesareemerginginevolvingsystem
• Pa4entnavigators• Casemanagers• Carecoordinators• Communityhealthworkers• Caretransi4onspecialists• Livingskillsspecialists• Pa4entfamilyac4vator• Peerandfamilymentors• Peercounselors
Ø Allplayroleinpa4enttransi4onsbetweenhome,community,ambulatoryandacutecarehealthsefngs
Ø Evidenceshowsimprovedcaretransi4onsreduceunnecessaryhospitaladmissions,lowercostsandimprovepa4entsa4sfac4on
EmergingRoles ImplicaKons
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It’scomplicated
• Newrolesmaybefilledbyexis4ngstaffornewhires
• Someroleshavesimilarfunc4onsbutdifferent4tles—caremanagersandcasemanagers
• Otherroleshavedifferentfunc4onsbutsamename—paKentnavigators
• Dependingonsefngandpa4entpopula4on,rolesareoYenfilledbydifferenttypesofproviders—medicalassistants,socialworkers,nurses,etc.
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Socialworkersplayincreasinglyimportantboundaryspanningroles
SocialworkersservingthreefuncKonsonintegratedbehavioralhealth/physicalhealthteams:
• Behavioralhealthspecialists:provideinterven4onsforpa4entswithmentalhealth,substanceabuseandotherbehavioralhealthdisorders
• CareManagers:coordinatecareofpa4entswithchroniccondi4ons,monitorcareplans,assesstreatmentprogressandconsultwithprimarycarephysicians
• Referralrole:connectpa4entstocommunityresourcesincludinghousing,transporta4on,food,etc.
Fraser M, Lombardi B, Wu S, Zerden L, Richman E, Fraher E. Social Work in Integrated Primary Care: A Systematic Review. Program on Health Workforce Research and Policy, Cecil G. Sheps Center for Health Services Research. September 2016. http://www.shepscenter.unc.edu/wp-content/uploads/2016/12/PolicyBrief_Fraser_y3_final.pdf
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Andnewhealthcareteamsareemerging:CommunityAginginPlace—AdvancingBecerLivingforElders(CAPABLE)Teams
• AnOccupa4onalTherapist,aRegisteredNurse,andahandymanformteamallowingseniorstoageinhomes
• Provideassis4vedevicesandmakehomemodifica4onstoenablepar4cipantstonavigatetheirhomesmoreeasilyandsafely
• AYercomple4ngfive-monthprogram,75percentofpar4cipants(n=281adultsage65+)hadimprovedtheirperformanceofADLs
• SymptomsofdepressionandabilitytoperforminstrumentalADLssuchasshoppingandmanagingmedica4onsalsoimproved
• Healthsystemsaretes4ngCAPABLEonalargerscale
h[p://nursing.jhu.edu/faculty_research/research/projects/capable/
Source: Szanton SL, Leff B, Wolff JL, Robers K, Gitlin LN. (2016). Home-Based Care Program Reduces Disability And Promotes Aging In Place. Health Affairs; Sep 1;35(9):1558-63.
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Wheredoesnursingfitin?Willwefaceanursingshortage?
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Shortage?Noshortage?Dowereallyknow?
• Na4onalnursingmodelsmixed:somesuggestshortage,othersexcesssupply
• Evenrecently,graduatesinstatespredictedtobeinshortagewerenotgefngtheirfirst,orevensecond,employmentchoice
• HRSAprojectsSouthCarolinawillbasicallybeinbalancein2025(600nursesshortonbasesupplyof54,000)
• Doesthisprojec4on“feelright”?
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NumberofnewNCLEXtakersincreasingrapidly
Between2001-2011:• Numberofbachelor’s
preparedRNcandidatestakingtheNCLEX-RNexammorethandoubled
• AssociatedegreecandidatestakingtheNCLEX-RNexamexperienceda99%growth
Figure19:GrowthinNCLEX-RNFirst-TimeTestTakers,byBachelor’sandNon-Bachelor’sDegreeStatus,2001to2011
DataSources:HRSAcompila4onofdatafromtheNa4onalCouncilofStateBoardsofNursing,NurseLicensureandNCLEXExamina4onSta4s4csPublica4ons,2002-2012,andfromtheNa4onalCouncilofStateBoardofNursing,“NumberofCandidatesTakingtheNCLEXExamina4onandPercentPassing,byTypeofCandidate,”h[ps://www.ncsbn.org/Table_of_Pass_Rates_2011.pdf
Source:Na4onalCenterforHealthWorkforceAnalysis,HRSA,h[p://bhpr.hrsa.gov/healthworkforce/supplydemand/nursing/nursingworkforce/nursingworkforcefullreport.pdf,pgs37-38,accessed11/5/15.
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Butontheground,we’rehearingaboutnursingshortages.Why?
Coulditbethatourmodelsarenotaccurate(GASP!)?
• Wemodeloverallsupplyandnotsupply/demandinspecificprac4ceareaslikeICU,ER,L&DandOR– Arethereshortagesforspecialtynurses?
• Re4rementassump4onshaveLARGEeffectonmodels.Maybeourmodelsdon’thaveit“right”?
– Arebabyboomersnowbeginningtore4reinlargernumbers?
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Maybewe’renotmodelingdemandcorrectly?
• Demandmaybeupduetoabe[ereconomy,increasedinsurancecoverageandagingpopula4on
• Demandhasincreasedinoutpa4entsefngsandinpa4entnursing-whichhasalwaysbeenpopular-isnowcompe4ngwithothersefngs
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Maybethereisamismatchbetweenwhateducatorsproduceandemployerswant?
• Hospitalswantexperiencednursesandarenothiringnewgradsbecausetheyarenotgradua4ngwiththeclinicalexper4sethathospitalswant
• Healthsystemsareseekingnursesfornewrolesinpa4entengagement,carecoordina4on,informa4csandotherfunc4onsinnewmodelsofcare(moreonthatlater….)
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AcriKonseemstobeontherise,FTEonthedecline
• A[ri4onofnewnursesseemstobeincreasing.Why?
• BSNsarenotstayingtheworkforce—theywanttobecomeadvancedprac4cenursesandareleavingtheworkforcetogobackschool
• Millennialsdon’twanttoworkasmanyhoursandarenottakingonextrashiYs
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Otherreasonswhyourmodelsmaynotbecorrect
• Hiringinterna4onallytrainednurseshasbecomemoredifficult
• Paymentmodelsarechanging—maybevalue-basedpaymentmodelsemploymorenurses?
• Other?
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Butlet’sshilthedialogue
Focusingonwhetherwehaveanursingshortagedistractsusfromamoreimportantques4on:
Willwehavetherightmixofnursesinthe
rightloca9ons,special9esandprac9ceseCngs
withtheskillsandcompetenciesneededtomeet
thedemandsofatransformedhealthcaresystem?
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Thefuturenursingworkforce:Newrolesinatransformed
healthsystem
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WhythenursingworkforceiscriKcaltohealthsystemtransformaKon
• Withnearly3millionnursesinac4veprac4ce,nursingisbyfarthelargestlicensedhealthprofession(aboutfourImesasmanynursesasphysicians)
• Nursingcarelinkedtoqualityandsa4sfac4onmeasuresthatwillincreasinglybe4edtovalue-basedpayments
• Nursesprovidewhole-personcareacrosshealthandcommunity-basedsefngs
• Nursesaretheul4mate“flexible”workforcetakingonnewrolesintransformedhealthsystem
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WorkforceisshilingfromacutetocommunityseWngs
• Changesinpaymentpolicyandhealthsystemorganiza4on:– ShiYfromfee-for-servicetowardrisk-andvalue-basedmodels– Finesthatpenalizehospitalsforreadmissions
• WillincreasinglyshiYhealthcare—andthehealthcareworkforce—fromexpensiveinpa4entsefngstoambulatory,communityandhome-basedsefngs
• Butwegenerallyeducatenursesininpa4entsefngs
• Currentworkforcenotadequatelypreparedtoworkinambulatorysefngsandpa4ents’homes
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WhiletheoverallpercentofSouthCarolinanursesemployedinhospitalshasn’tchanged
Source: SC Office for Healthcare Workforce, RNs active in the South Carolina workforce based on self-reported employment information provided during the biennial license renewal period, years 2004 – 2014.
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ThepercentworkinginpaKenthasdecreased,andpercentin“hospital-wide”roleshasincreased
Source: SC Office for Healthcare Workforce, RNs active in the South Carolina workforce based on self-reported employment information provided during the biennial license renewal period, years 2004 – 2014.
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Nursingworkforce:Newroles,newrules
Cita4on:FraherE,SpetzJ,NaylorM.NursinginaTransformedHealthCareSystem:NewRoles,NewRules.LDI/INQRIResearchBrief.June2015.h[p://ldi.upenn.edu/uploads/media_items/inqri-ldi-brief-nursing.original.pdf.
“Whatwillittaketoop9mizecontribu9onsofnurses?• Redesignthenursingcurriculumtoeducatenurseswithnewcompetencies;• RetrainexisIngnurseswithnewskillsandknowledge;• RevamplicensingexaminaIonandrequirementstoreflectthenewcurriculum;and• Restructurethestateregulatorysystemtoallowflexibledeploymentofthenurseworkforce.”
h[p://www.shepscenter.unc.edu/wp-content/uploads/2015/07/inqri-ldi-brief-nursing.original.pdf-QuotedfromJanetWeiner,MPH.PennLDIVoicesBlog.“Re:Nurses”.
June25,2015.hep://ldi.upenn.edu/voices/2015/06/25/re-nurses
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RegisteredNursesareunderuKlizedinprimarycare
1. CulturechangeneededtoelevateprimarycareinRNeduca4on
2. Prac4cesshouldredesigncaredeliverymodelstobe[eru4lizeRNskills
3. Educatorsneedtoputmoreemphasisonprimarycarecontent
4. Lifelonglearningopportuni4esneededtosupportRNsinprimarycare
5. Be[eralignmentneededbetweenRNeduca4onandprac4ce
6. Moreinterprofessionaleduca4onandteamworkneededincurricula
h[p://macyfounda4on.org/docs/macy_pubs/201609_Nursing_Conference_Exectuive_
Summary_Final.pdf
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PhysicianWorkforceIssues&GraduateMedicalEducaKon
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ExpertsdisagreeaboutwhethertheUnitedStateswillfaceashortage
• AAMCprojectsshor�allsofbetween12,500and31,000primarycarephysiciansand46,100and90,400totalphysiciansby20251
• Federalgovernment(HRSA)forecastsshortageof6,400primarycarephysiciansin20202withincreaseduseofNPsandPAs
• WereleasedmodelinJuly2014thatsuggestsoverallsupplywillbeadequate,morepressingissueismaldistribu4onbyspecialtyandgeography
1 AAMC, https://www.aamc.org/download/426242/data/ihsreportdownload.pdf?cm_mmc=AAMC-_-ScientificAffairs-_-PDF-_-ihsreport 2 HRSA, http://bhpr.hrsa.gov/healthworkforce/supplydemand/usworkforce/primarycare/projectingprimarycare.pdf
h[ps://www2.shepscenter.unc.edu/workforce
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This project is funded by a grant from The Physicians Foundation.
OurmodelhighlightsthatweareanaKonof“haves”and“have-nots”
Shortage/Surplus for All Visits, All Settings, 2014 Aurora,IL
NewOrleans,LA
Washington,DC
Boston,MA
NewYork,NY
SanFrancisco,CA
Slidell,LA
Rochester,MN
Boulder,CO
HunIngton,WV
Bangor,ME
MelrosePark,IL
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This project is funded by a grant from The Physicians Foundation.
AndthatexpectedgrowthinNPsandPAswilloffsetphysicianshortages
NP/PA Increase by 3%
Baseline
NP/PA Increase by 6%
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42
* Counts include master’s and post-master’s NP and NP/CNS graduates, and Baccalaureate-to-DNP graduates. Source: American Association of Colleges of Nursing (AACN) and National Organization of Nurse Practitioner Faculties (NONPF) Annual Surveys
Gra
duat
es
GrowthinNursePracKKonerGraduates*2001-2015
Growth from 2014 to 2015 : 20.3%
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This project is funded by a grant from The Physicians Foundation.
ForSC,ourmodelforecastsstableoverallsupplybutdecliningsupplyinprimarycare
PrimaryCareAllspecial9es
13.1 13.5 6.0 4.9
PhysicianSupply,FTEper10,000PopulaKon,SouthCarolina,2013-2030
h[ps://www2.shepscenter.unc.edu/workforce
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This project is funded by a grant from The Physicians Foundation.
SouthCarolinalikelytofaceexcessdemandforhealthcarevisits
= supply of visits physicians can provide utilization of visits needed by population
h[ps://www2.shepscenter.unc.edu/workforce
RelaKveCapacityofPhysicianSupplytoMeetDemandforVisits,SouthCarolina,2013-2030
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This project is funded by a grant from The Physicians Foundation.
WhatifweactuallyusedworkforcedatatodeterminewheretoinvestinGME?Weusedmodeltodeterminehowtotargetproposed3,000PGY1slotstomeetan4cipatedshortagesn FindingssuggestexpandingGMEinstateswith:
q Poorhealthoutcomesandhighhealthcareu4liza4on(Arkansas,MississippiandAlabama)
q Large,growingpopula4ons(TexasandCalifornia)q Agingpopula4ons(Florida)q Lowresident/popula4onnumbers(Idaho,Wyoming,Montana,
AlaskaandNevada)n 5states(Connec4cut,Delaware,NewHampshire,RhodeIslandand
Vermont)andtheDistrictofColombiareceivenoGMEslotsbecausetheyarealreadywellsupplied
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SouthCarolinawouldreceive64newPGY1posiKons
Specialty Cardiology 6 Dermatology 2 Emergency Medicine 3 Family Medicine 6 Gastroenterology 3 General Pediatrics 3 Gynecology/Obstetrics 2 Infectious disease 4 Internal Medicine 9 Nephrology 2
Modelproposes64newPGY1posiKonsinSouthCarolina
Specialty Oncology 5 Other Physician Specialty 2
Pediatric Non-Surgical Specialties
3
Plastic Surgery 2 Psychiatry 2 Pulmonology 2 Surgery 4
Thoracic Surgery 2
Urology 2 New PGY1 Slots 64
# PGY1 Slots # PGY1 Slots
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Werecentlycompletedstudyoftenstates’effortstoreformMedicaidGMEWhystudystates?
• FederalGMEreformeffortshavestalled
• Statesare“policylaboratories”forGMEinnova4on
• Manystatesinves4nginGMEwithMedicaiddollars:
– In2015,43statesandDCmadeMedicaidGMEpayments
– TotalMedicaidGMEpaymentsincreased10%from$3.87billionin2012to$4.26billionin2015
h[p://www.shepscenter.unc.edu/programs-projects/workforce/projects/carolina-health-workforce-research-center/
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StudyisKmely
• Withchangeoffederaladministra4on,policywindowmaybeopeningforincreasedstateinvolvementinGME
• Poten4alforMedicaidblockgrantsorpercapitaallotmentscouldacceleratestate-levelGMEreform
• Statesfacingbudgetconstraintsandpressuretoiden4fyreturnoninvestmentforpublicfundsspentonGME
• Thisstudysoughtto:– Inves4gatehowstatesarereformingMedicaidandstate-fundedGMEfinancing
– Iden4fyinnova4onsandchallenges
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Whatwefound
• Highlevelofinterest,limitedreformofMedicaidGME
• MoststatesseekingnewGMEappropria4ons,notredistribu4ngexis4ngfunds
• Oversightbodiesplaycri4calroleineduca4nglegislatureandnaviga4ngcompe4ngGMEinterests
• Weheardloudcallforincreasedaccountability/transparency
• Cri4calneedforbe[erdataandmetricstomeasureworkforceoutcomesofresidencytraining
h[p://www.shepscenter.unc.edu/programs-projects/workforce/projects/carolina-health-workforce-research-center/
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Workforceplanningthefuture:Howdowegettherefromhere?
It’snotjustaboutretoolingtheworkforce.Weneedtoretoolthesystemthatsupportstheworkforce:educa4on,prac4ceandregula4onneedstobemoreresponsivetochangesinfront-linehealthcaredelivery
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WeneedtobecerconnecteducaKontopracKce
“RevoluIonarychangesinthenatureandformofhealthcaredeliveryarereverberaIngbackwardinto…
educaIonasleadersofthenewpracIceorganizaIonsdemandthattheeducaIonalmissionberesponsivetotheirneedsforpracIIonerswhocanworkwithteamsinmoreflexibleand
changingorganizaIons…”
• Buteduca4onsystemislaggingbecauseitremainslargelyinsulatedfromcaredeliveryreform
• Needcloserlinkagesbetweenhealthcaredeliveryandeduca4onsystems
Source:RickecsT,FraherE.ReconfiguringhealthworkforcepolicysothateducaKon,training,andactualdeliveryofcarearecloselyconnected.HealthAff(Millwood).2013Nov;32(11):1874-80.
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OnpracKceside:redesignhumanresourceinfrastructuretosupportnewroles
• Needtominimizeroleconfusionbyclearlydefiningandtrainingfornewfunc4ons
• Jobdescrip4onshavetoberewri[enorcreated
• Workflowshavetoberedesigned
• Lackofstandardizedtrainingandfundstosupporttrainingisbigobstacle
• Exis4ngstaffwon’tdelegateorsharerolesifdon’ttrustotherstaffmembersarecompetent
• Timespenttrainingisnotspentonbillableservices
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Howdoweredesignstructurestosupportnewroles?EducaKon
• Retrainandupgradeskillsofthe18millionhealthcareworkersalreadyinthesystem–theyaretheoneswhowilltransformcare
• Trainingmustbeconvenient–4ming,loca4on,andfinancialincen4vesmustbetakenintoconsidera4on
• Needtopreparefacultytoteachnewrolesandfunc4ons
• Clinicalrota4onsneedtoinclude“purposefulexposure”tohigh-performingteamsinambulatorysefngs
• Needtoredesigneduca4onsystemsoworkforcecanflexiblygainnewskillsandcompetenciesthroughoutcareer
Source:FraherE,SpetzJ,NaylorM.NursinginaTransformedHealthCareSystem:NewRoles,NewRules.LDI/INQRIResearchBrief.June2015;Laddenetal.TheEmergingPrimaryCareWorkforce.PreliminaryObserva4onsfromthePrimaryCareTeam:LearningfromEffec4veAmbulatoryPrac4cesProject”.AcademicMedicine;1013,88(12):1830-1835.
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Goal:flexibleworkforcethatcanadapttorapidlychanginghealthcaresystem
Bothnewentrantstotheworkforce
Andour“seasonedworkers”
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“The workforce innova4ons needed to implement ACA programs require an adaptable regulatory system capable of evolving with the health care environment. The health profession regula4on system in place today
does not have the flexibility to support change
Howdoweredesignstructurestosupportnewroles?RegulaKon
Tocreateamoredynamicregulatorysystem,weneedto:• developevidencetosupportregulatorychanges,especiallyfornewroles• evaluatenew/expandedrolestounderstandifinterven4onsimprovehealth,
lowercostsandenhancesa4sfac4on• removeregulatorybarrierstoletworkforceu4lizeskillstomaxbenefit
ofpa4ents
Source:DowerC,MooreJ,LangelierM.Itis4metorestructurehealthprofessionsscope-of-prac4ceregula4onstoremovebarrierstocare.HealthAff(Millwood).2013Nov;32(11);FraherE,SpetzJ,NaylorM.NursinginaTransformedHealthCareSystem:NewRoles,NewRules.LDI/INQRIResearchBrief.June2015.
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HealthWorkforcePlanningtheTradiKonalWay
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WeneedtobelikeWayneGretsky
….but how do we know where the
puck is going to be?
“Iskatetowherethepuckisgoingtobe,nottowhereithasbeen.”−WayneGretsky
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Contactinfo
ProgramonHealthWorkforceResearchandPolicyhcp://www.healthworkforce.unc.edu
(919)966-5012