Seizing the Health Human Resource Future: Changing the Culture, Positioning for Success Presentation...
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Transcript of Seizing the Health Human Resource Future: Changing the Culture, Positioning for Success Presentation...
Seizing the Health Human Resource Future:Changing the Culture, Positioning for Success
Presentation to the CAAHP Annual General Meeting
Ottawa, May 28, 2014
Steven LewisAccess Consulting Ltd.
Saskatoon SK(306) 343-1007
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What This Presentation Is About
Why health care is what it is Why health care is about to change Implications for the workplace Implications for the workforce Implications for health science education Winning conditions for tomorrow’s workforce
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My Perspective
How we educate and deploy people should be based on needs
There is a mismatch between what people need and what the system delivers
Meeting needs successfully will require significant changes in the classroom and the workplace
It will require a coalition of educators, employers, and governments to get this done
These issues are not settled – feel free to disagree
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Part 1
History Is Not Destiny:A Dose of Realism Tempers a
Century of Boundless Optimism
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The Century of Achievement and Optimism
The 20th century created modern health care Life expectancy rose 30 years Major diseases were conquered (polio, smallpox) Technological innovation flourished Occupations grew in number and became highly
professionalized Scientific knowledge increased exponentially Dramatic repair work (antibiotics, transplants, CABG,
Tommy John surgery for baseball pitchers)
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And We Thought It Would Only Get Better
Science will solve every health problem – just a matter of time and effort
More is better:ImagingScreeningSurgical repairDrugs
Specialization is good; sub-specialization is better
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Then Reality Set In
To Err Is Human in US; Baker-Norton in Canada – the system isn’t very safe
The system fails at the basics:Hand-washingEvidence-based preventive care (McGlynn et al)
More can be worsePSA and mammography screeningPolypharmacyCT scanning
Specialization is a risk factor (complexity)
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But the Triumphalist Culture Persists
Sophisticated diagnostics Emergency interventions Surgery Drugs Big Science (genomics, proteomics)
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What If We Started Over and Designed the System to Meet Societal Needs?
Chronic diseases consume 70% of health spending Mental health problems are under-diagnosed and poorly
addressed Science has yet to find cures for the most prominent
pathologies Aging and frailty are the most dominant health problems The search-and-destroy paradigm of medical miracles
does not apply in these circumstances
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What Most People Need to Thrive
Providers who listen as much as they talk Coaching to support self-management Relationships based on trust Practical, on-the-ground problem solving Emphasis on quality of life and adaptation Engagement in their care planning and respect for their
perspectives, values, choices
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Or Put Another Way…
Patient-centred, holistic care Better quality Better value-for-money (VFM) Reduced disparities between population groups More effective prevention and chronic disease
management Integrated, effective primary care Interdisciplinary collaborative practice More self-reliant, health-oriented public
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Part 2
Implications for Health Human Resources
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Why the Workforce Looks Like It Does
Regulation gave major boost to safety in early part of 20th century
Increased complexity of health care led to increased specialization
Expansion of scientific knowledge created rationale for longer educational programs
Intrinsic societal belief in more education, higher credentials
Turf = control = power = money
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Is the Contemporary HHR Approach Compatible With System Goals?
High degree of specialization a challenge to holistic, integrated care
Professions develop distinct theories and cultures of health and health care which risks fragmentation
Increasing entry-to-practice credentials makes workforce adjustments long and difficult
Entrenched hierarchies and power inequalities Battles over scope of practice and gatekeeping role
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The Revival of Generalism
The reorganization and renewal of primary health careInterdisciplinaryHolisticMore effective division of labour
Whole-person focus with integrated approach to care Shift from prescriptive interventionist role to coaching
and shared power arrangement Repatriation of work from specialists
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What Makes Effective Health Care Workers?
Less autonomous practice, more teamwork Greater emphasis on communications, coaching,
behaviour modification skills More fluid division of labour among occupational
categories Relationships and deep understanding of patients at
least as important as technical skills
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The Policy Front: Will Frustrations Lead Governments to Insist on Change?
“Credential creep” fatigue – the higher credentials aren’t creating a better system
Shift locus of health science education to colleges from universities
Expand scope of practice of technicians and aides Mandate interprofessional training, team-based
practicums Press for inclusion of more systems thinking and quality
improvement in curricula
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Part 3
Opportunities for Allied Health Professions:Needs, Roles, Strategies
REPLACEABLE WORK
IRREPLACEABLE WORK
Physiological measures Motivation
Diagnostics based on pattern recognition
Calming of fear and anxiety
Scheduling and reminders
Decisions under conditions of uncertainty
Reasoning based on algorithms
Communicating effectively
Solutions that are context-independent
Knowing when to deviate from standard procedure
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Lessons from US Manufacturing
Old model of US manufacturing: low-skill assembly-line mass production
Threat: cheap labour and economies of scale in developing nations
Result: major decline in US manufacturing sector Insight: identify high-value-added, high quality end of
manufacturing that cannot be outsourced New workforce model: diploma-trained personnel
working with complex, computer-based machinery
OLD CULTURE EMERGING CULTURE
Hierarchical Egalitarian
Prescriptive Collaborative
Tradition-driven Evidence-driven
Acute focused Chronic disease focused
Fragmented Integrated
Autonomous Interdependent
OBSOLETE TRAITS
HIGH DEMAND TRAITS
Narrow set of skills that can be automated
Patient-centred skills
Non-transferable specialization
Versatility
Autonomous team members
Interdependent team members
Authoritarian personality Empathetic personality
High control needs Comfortable with interdependence
Need for order and stability
Ability to adapt and create
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The Evidence Is Already In
Most scope of practice expansion has been highly successful:Nurse anaesthesia, endoscopy, NPsLPNs in all settingsDental therapistsRehab therapists as diagnosticians
Main barriers are professional self-protection and obsolete standards and regulation
The workplace and experience are great teachers that expand capabilities
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Potential for Substitution
“Labour substitution: Is a plausible strategy for addressing workforce shortages
Can reduce (wage) costs - under certain conditions which can be challenging to meet
Can improve efficiency - under restricted conditions which are difficult to meet”
Source: Univ. of Manchester, Centre for Workforce Intelligence, http://www.cfwi.org.uk/publications
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Cultural Changes on the Horizon
Standardized work (care pathways, diagnostic algorithms)
Self-organizing teams with fluid division of labour Assertive generation that exercises greater control over
nature of care Enhanced transparency and more robust public
reporting about safety, quality, efficiency
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Teamwork
Fundamental disconnect between health are hierarchy and optimal team functioning
Self-organizing teams that allocate work to maximize value of all members is ultimate goal
Interdependency and trust are prerequisites for best combination of quality and efficiency
Providers prepared to work in teams and understand team dynamics are key to developing care models
A relentless focus on safety and quality breaks down hierarchy – “stop the line” is the new mantra
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Skill Sets for a Better Future
Ability to apply sophisticated technologies effectively Coaching and motivation for self-management and
successful adaptation Flexibility and multi-tasking in changing environments Data-driven quality improvement Team-based problem-solving
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What Kind of People Are We Looking For?
Versatility and adaptability Emotional intelligence in workplace Empathy and culture of service toward clients Communication
Within teams and organizationsWith people served
Creative problem-solving
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Keep Education Short, Modular, and Experience-Based
The workforce needs educational programs that produce job-ready graduates in a timely manner
Avoid temptation to lengthen formal training – it reduces pool of interested students, adds costs, reduces agility
Enhance life-long modular learning opportunities Remove needless barriers to shifts in career direction
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Match Program Design to Needs
Aging and frailty Working with families Coaching and self-management Recognizing mental health issues
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Expose Students to System Concepts
Accountability Value for Money Indicators Quality Improvement Patient-Centered Care
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Influence Regulation and Legislation
Champion evidence-based scope of practice Question unjustified barriers to deployment of
knowledge and skills Make the process transparent and engage employers
and the public in discussions Ensure governments and employers understand
changes in competency
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Be Careful About Specialization
Narrow job descriptions and competency profiles risk obsolescence
Workplaces need skilled personnel who can evolve continuously as the environment changes
Some highly technical work demands specialization but a great deal does not
Knowing how to problem-solve where uncertainty exists is the value proposition for health care in the future
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Create A Service Culture
The patient experience is as important as the technical aspects of care
Convenience, communication, and relationships are critical to the patient experience
Organizing work around the needs and preferences of patients is revolutionary