Access to high-quality health care is a fundamental human right, for improving the health of both individuals and the population as a whole. Health professionals are the most important asset in any health system and represent a significant investment. While countries differ in how they fund health care, how much they are prepared to pay for services and which services they prioritise, the quality of care is dependent on having the right professionals with the right skills in the right place at the right time. This week we launched our latest report, Time to care: Securing a future for the hospital workforce in Europe. The overarching theme is a universal concern about workforce shortages and the lack of time for hands-on care. Countries across Europe are facing increasing challenges with regard to the growing demands placed on the workforce which raises important questions about the sustainability of current workforce models. Having led the research for this report for the past six months, this week's blog provides my take on the report's key findings, the challenges identified and some of the potential solutions to these challenges.
Time to care
In countries across Europe hospitals are the largest employer of doctors and nurses with the workforce accounting for some 60 to 70 per cent of hospital spending. Our research findings are based on:
- extensive literature reviews
- analysis of international datasets
- structured interviews with executive directors policy makers and professional bodies responsible for the hospital workforce in 14 countries (Belgium, Denmark, Finland, Germany, Iceland, Ireland, Italy, Luxembourg, Netherlands, Norway, Spain, Sweden, Switzerland, UK)
- a survey of over 1,350 doctors and nurses working in hospitals across 11 European countries
- insights from colleagues working with health care clients across the world.
In conducting the research for the report I was privileged to meet an amazing number of committed dedicated professionals and engage with colleagues and key stakeholders in all of the countries covered by our research. Importantly, our visits to hospitals provided me with an opportunity to see first-hand: the challenges faced in meeting today's demands; approaches to securing tomorrow's workforce; and how organisations across Europe are addressing these challenges. I heard of deep seated concerns about the future of the health care workforce, with only two out of more than 50 senior leaders believing that they are well prepared to tackle future workforce challenges. Most identified the need to improve staff satisfaction, recruitment and retention and increase workforce productivity. Senior leaders also shared impressive initiatives aimed at rethinking the way care is delivered, improving recruitment and workforce management and transforming organisational cultures to create the conditions that will allow professionals to grow and develop.
Health care leaders and front line staff share concerns about workforce shortages and the lack of time for hands-on care
Our survey results of 1,350 staff working across 11 countries, indicated that doctors in 8 countries, and nurses in 10 countries reported an increase in their workload over the past 5 years, predominantly driven by increases in patient numbers and workforce shortages. The research also found that in 7 out of 11 countries, over 50 per cent of respondents reported that workload pressures were having a negative effect on their mental and physical health. Across Europe over 27 per cent of nurses indicated that they were thinking of leaving the profession, while over a third of doctors intended to reduce their working hours to part-time working, and a quarter reported plans to leave the country where they were currently practising to work elsewhere.
The challenge of securing the future of the hospital workforce cannot be solved in silos
The World Health Organisation is predicting a shortfall of up to two million health professionals across the EU by 2020, and a global shortfall of 18 million health professionals. Interviewees across all countries are experiencing staff shortages to varying degrees, especially in specific medical and nursing specialities, and in more rural areas. Our interviewees showed a growing understanding that the global market for talent was shrinking and acknowledged that looking to international recruitment to fill vacancies was not sustainable in the long term. However, most interviewees also recognised the need to guarantee some flow of professionals between countries to secure knowledge exchange.
The multi-disciplinary workforce is the biggest asset of a health system
Across all countries, leaders, managers and front line health professionals accepted the need to innovate to improve how the systems they work in operate. Most acknowledged that organisations and governments needed to shift their mind-set from seeing the workforce as a cost to be controlled, to viewing it as a significant and worthwhile investment in ensuring the delivery of productive and high-quality care. A recurring theme was that tackling the workforce challenge would require them to look 'beyond the numbers game', and offer the workforce more flexibility in both career and job planning. Interviewees identified the need for more reliable staff schedules, more opportunities for continuing professional development and a culture in which employee participation is encouraged, decision making is transparent and communication strategies are deployed effectively. In the words of one medical director, "If you train them right, and create the conditions to keep them well, you have more chance in retaining them and creating safer patient care."
The health care industry is on the edge of a technology enabled step change
There was increasing acceptance that technology will underpin most aspects of care in the future, but that care delivery will still require distinctively human capabilities, such as creativity, social and emotional intelligence. Currently, electronic health record systems are the most widely applied technology, however, most interviewees recognised that these were not used to their full capacity. Advanced technologies, such as artificial intelligence (AI), robotics and virtual reality, were hardly mentioned by our survey respondents, reflecting their current level of adoption of such technologies. The exponential increase in the pace and scale with which new technologies are emerging means that adapting to the future of work will require task shifting and task reorganisation. It will also require health professionals to be educated in new ways and for policymakers, senior management and human resource professionals to seize the opportunity to think creatively, and focus on the opportunities that technologies offer to help make hospitals more efficient, productive, affordable, and jobs more meaningful and engaging.
To secure the future of health care organisations will need to be open to learn from other industries and from each other
A key part of the research was discussing current and potential solutions with interviewees as the findings of the report emerged. Most were eager to learn from successful strategies trialled and implemented elsewhere. Based on these discussions and evidence based examples of good practice we developed sixteen case studies that identify solutions to the challenges identified and which we believe have the potential, if adopted at scale, to address some of the skills and talent shortages, in a more effective and sustainable way.
Future workforce shortages could be tackled more effectively, if the efficiency and productivity of clinical activities were addressed through innovative approaches to workforce planning, recruitment and skills development. Progress in tackling the imbalance between demand and supply for hospital staff will require significant political commitment and investment, and an open public debate to strengthen health care systems in a systematic manner. This includes aligning incentives for digitisation and service integration and adopting intelligence -based workforce planning and new approaches to education and training of health care staff.
I hope that our findings and good practice case examples will stimulate debate and encourage actions for hospitals and the wider health care system. In particular I consider that the adoption of technology is an imperative if health care is to catch up with, and optimise the innovation being implemented by other industries. This should enable hospitals to embrace new ways of working in order to secure a future for the hospital workforce.
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