Rethinking workforce planning for integrated care: using scenario analysis to facilitate policy development

Abstract

Background: A goal of health workforce planning is to have the most appropriate workforce available to meet prevailing needs. However, this is a difficult task when considering integrated care, as future workforces may require different numbers, roles and skill mixes than those at present. With this uncertainty and large variations in what constitutes integrated care, current health workforce policy and planning processes are poorly placed to respond. In order to address this issue, we present a scenario-based workforce planning approach. Methods: We propose a novel mixed methods design, incorporating content analysis, scenario methods and scenario analysis through the use of a policy Delphi. The design prescribes that data be gathered from workforce documents and studies that are used to develop scenarios, which are then assessed by a panel of suitably qualified people. Assessment consists of evaluating scenario desirability, feasibility and validity and includes a process for indicating policy development opportunities. Results: We confirmed our method using data from New Zealand's Older Persons Health sector and its workforce. Three scenarios resulted, one that reflects a normative direction and two alternatives that reflect key sector workforce drivers and trends. One of these, based on alternative assumptions, was found to be more desirable by the policy Delphi panel. The panel also found a number of favourable policy proposals. Conclusions: The method shows that through applying techniques that have been developed to accommodate uncertainty, health workforce planning can benefit when confronting issues associated with integrated care. The method contributes to overcoming significant weaknesses of present health workforce planning approaches by identifying a wider range of plausible futures and thematic kernels for policy development. The use of scenarios provides a means to contemplate future situations and provides opportunities for policy rehearsal and reflection.

Tackling the primary healthcare workforce crisis: time to talk about health systems and governance. A comparative assessment of the European region

“…Others have addressed the 'layered' nature of the PHC workforce crisis and emphasised that the 'causes at the heart of such crisis, and their patterns and implications differ across the very diverse European region' [30]. Longing for a broad and inclusive 'one-size-fits-all' PHC model may risk obscuring these layers and diverse conditions and institutional prerequisites, including powerful professional stakeholders and interests, necessary for effective policy recommendations [12,20,[31][32][33][34].…”

“…PHC's far-reaching promises of universal health coverage (UHC) [4,29,35] and equity [4,29,36] strengthen the appeal of uniform concepts silencing the critical debate and eventual emerging controversies pertaining to strategies, actors and future directions [12,20,32,[37][38]. Crucially, governance largely remains a black box, hiding the systematic analysis of transformative capacities and making PHC workforce governance poorly prepared for the implementation challenges embedded in politics, policy, and the powers of stakeholders within health systems.…”

Enabling action: Re-envisaging education of health professionals in Aotearoa New Zealand

“…Quantitative approaches to analysing services and predicting staffing numbers are more likely to replicate existing roles and skillsets than enable new and innovative opportunities for defining services and practice. Simple approaches to workforce planning consider historical numbers within individual groups of practitioners without necessarily referencing future needs (Rees et al, 2020).…”

Health workforce planning under conditions of uncertainty: identifying supportive integrated care policies using scenario analysis

“…Secondly, we contribute to workforce policy making by showing how a wider range of methods can contribute to addressing policy challenges (Walt et al, 2008;Dunn, 2004). Our intention here is to focus more on our results, as the method has been comprehensively covered elsewhere (Rees et al, 2020). Thus, the article proceeds by examining the nexus between integrated care, health workforce planning and policy making, followed by a brief description of our method, leading to a deeper presentation of our results revealing sector-based preferences and suggestions for policy directions.…”