Regional health workforce monitoring as governance innovation: a German model to coordinate sectoral demand, skill mix and mobility

Kuhlmann, Ellen; Lauxen, Oliver; Larsen, Christa

doi:10.1186/s12960-016-0170-3

Cited by 11 publications

(9 citation statements)

References 34 publications

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“…This estimation however is becoming increasingly challenging due to the international mobility of the health workforce [16][17][18]. Evidence-based planning through modeling is used in many countries, including Australia, Belgium, Canada, Germany, Finland, Ireland, and Oman [6,13,14,17,19,20].…”

Section: Planning Workforce and Training Needsmentioning

confidence: 99%

Human resources for health interventions in high- and middle-income countries: findings of an evidence review

et al. 2020

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Many high-and middle-income countries face challenges in developing and maintaining a health workforce which can address changing population health needs. They have experimented with interventions which overlap with but have differences to those documented in low-and middle-income countries, where many of the recent literature reviews were undertaken. The aim of this paper is to fill that gap. It examines published and grey evidence on interventions to train, recruit, retain, distribute, and manage an effective health workforce, focusing on physicians, nurses, and allied health professionals in high-and middle-income countries. A search of databases, websites, and relevant references was carried out in March 2019. One hundred thirty-one reports or papers were selected for extraction, using a template which followed a health labor market structure. Many studies were cross-cutting; however, the largest number of country studies was focused on Canada, Australia, and the United States of America. The studies were relatively balanced across occupational groups. The largest number focused on availability, followed by performance and then distribution. Study numbers peaked in 2013-2016. A range of study types was included, with a high number of descriptive studies. Some topics were more deeply documented than others-there is, for example, a large number of studies on human resources for health (HRH) planning, educational interventions, and policies to reduce in-migration, but much less on topics such as HRH financing and task shifting. It is also evident that some policy actions may address more than one area of challenge, but equally that some policy actions may have conflicting results for different challenges. Although some of the interventions have been more used and documented in relation to specific cadres, many of the lessons appear to apply across them, with tailoring required to reflect individuals' characteristics, such as age, location, and preferences. Useful lessons can be learned from these higher-income settings for low-and middle-income settings. Much of the literature is descriptive, rather than evaluative, reflecting the organic way in which many HRH reforms are introduced. A more rigorous approach to testing HRH interventions is recommended to improve the evidence in this area of health systems strengthening.

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Section: Planning Workforce and Training Needsmentioning

confidence: 99%

Human resources for health interventions in high- and middle-income countries: findings of an evidence review

et al. 2020

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“…The results show improvements in health workforce planning, including better knowledge about skill mix changes and cross-border mobility. 9 In Denmark, a recent regional initiative introduced team approaches and closer connections between health and social care in primary care. Research highlights that professional groups took an active role to ensure inter-professional collaboration.…”

Section: Plural and Multi-level Professional Stakeholder Involvementmentioning

confidence: 99%

Strengthening stakeholder involvement in health workforce governance: why we need to talk about power

Kuhlmann

Burau

2017

J Health Serv Res Policy

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There is now widespread agreement on the benefits of an integrated, people-centred health workforce, but the implementation of new models is difficult. We argue that we need to think about stakeholders and power, if we want to ensure change in the health workforce. We discuss these issues from a governance perspective and suggest a critical approach to stakeholder involvement as an indicator of good governance. Three models of involving stakeholders in health workforce governance can be identified: corporatist professional involvement either in a continental European model of conservative corporatism or in a Nordic model of public corporatism; managerialist and market-centred involvement of professions as organizational agents; and a more inclusive, network-based involvement of plural professional experts at different levels of governance. The power relations embedded in these models of stakeholder involvement have different effects on capacity building for an integrated health workforce.

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“…In total, 28 publications were identified. This included 12 case studies referencing domestic or regional governance in health workforce, either by outlining the general landscape and challenges (10) [ 14 - 23 ], or by promoting new governance-based approaches (2) [ 24 , 25 ]. Of the remaining sources, seven were broader systematic reviews, literature reviews, scoping studies, case studies or books that were able to consider governance more generally within health workforce [ 5 , 26 - 31 ], two were region-wide examinations of HRH units within countries [ 32 , 33 ], and six were editorials, research articles or other grey literature [ 7 , 34 - 38 ].…”

Section: Resultsmentioning

confidence: 99%

“…In summary, the conceptualisation of governance in health workforce literature is either process driven, outcome focused or both. Much of the literature extrapolates the concept of governance ad hoc from health governance; however, apart from the work of Kuhlmann et al [ 24 , 25 ] and more recently Teter [ 39 ], there has been little adaptation or tailoring of governance perspectives towards the specific characteristics and challenges within the health workforce.…”

Section: Resultsmentioning

confidence: 99%

“…One possibility could include stakeholder-driven governance deliberately weighted to ‘steward’ against dominant stakeholder influence. Kuhlmann et al have described a German regional health workforce monitor which counterbalances against the influence of one particularly strong stakeholder group (doctors) by excluding them from the governance process, thus directly connecting smaller diverse stakeholders with policymaking and ‘disrupting a cycle of ineffective health workforce policy’ [ 25 ]. Another possibility could include strong top-down leadership, seen when the Ethiopian government increased the production and deployment of doctors to fill workforce gaps despite resistance from professional bodies and medical schools [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

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Governance in health workforce: how do we improve on the concept? A network-based, stakeholder-driven approach

Lim

Lin

2021

Hum Resour Health

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Background Health workforce governance has been proposed as key to improving health services delivery, yet few studies have examined the conceptualisation of health workforce governance in detail and exploration in literature remains limited. Methods A literature review using PubMed, Google Scholar and grey literature search was conducted to map out the current conceptualisation of health workforce governance. We identified all published literature relating to governance in health workforce since 2000 and analysed them on two fronts: the broad definition of governance, and the operationalisation of broad definition into key dimensions of governance. Results Existing literature adopts governance concepts established in health literature and does not adapt understanding to the health workforce context. Definitions are largely quoted from health literature whilst dimensions are focused around the sub-functions of governance which emphasise operationalising governance practices over further conceptualisation. Two sub-functions are identified as essential to the governance process: stakeholder participation and strategic direction. Conclusions Although governance in health systems has gained increasing attention, governance in health workforce remains poorly conceptualised in literature. We propose an improved conceptualisation in the form of a stakeholder-driven network governance model with the national government as a strong steward against vested stakeholder interests. Further research is needed to explore and develop on the conceptual thinking behind health workforce governance.

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Regional health workforce monitoring as governance innovation: a German model to coordinate sectoral demand, skill mix and mobility

Cited by 11 publications

References 34 publications

Human resources for health interventions in high- and middle-income countries: findings of an evidence review

Human resources for health interventions in high- and middle-income countries: findings of an evidence review

Strengthening stakeholder involvement in health workforce governance: why we need to talk about power

Governance in health workforce: how do we improve on the concept? A network-based, stakeholder-driven approach

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