Innovative Solutions to Health Workforce Shortages

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Innovative Solutions to Health Workforce Shortages

• Communities in Crisis
• November 2, 2001
• Beth Mertz
• Project Director
• Center for the Health Professions

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Our mission is to assist health care
professionals, health professions schools, care
delivery organizations and public policy makers
respond to the challenges of educating and
managing a health care workforce capable of
improving the health and well being of people and
their communities.
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Presentation Outline

• Overview of rural health care considerations in
  context of health care systems change
• Diversity and the health care workforce
• Innovative solutions in allied health
• Recruitment and retention of primary care
  providers in rural areas
• Oral health systems in rural areas
• Summary / Future directions

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Winds that are blowing...

• A national crisis is looming for health workforce
  but it has more to do with lack of innovation,
  than with shortages of workers
• Three key trends
• Changing Demographics
• Technological Innovation
• Change to market driven health system

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The workforce is changing Are you ready for the
next generation?

• AGE Great depression/WWII era workers, Baby
  Boomers, and Generation X all see the world from
  a different vantage point
• RACE Moving from a majority culture (1995), to
  diversity (2005), to multicultural (2025)
• GENDER Dramatic expansion of career
  opportunities for women over past 30 years, not
  restricted to nursing and teaching

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Technology Driven Changes

• Biomedical
• US Investment in basic and applied biomed leads
  the world
• The next generation of technology promises to
  reduce cost, move care to ambulatory settings,
  and improve outcomes

• Information
• Health care is a knowledge based service
  enterprise
• Consumers are increasingly technology savvy

• Technological changes in
• health care are likely to
• increase the demand for
• skilled labor

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Market Pressures

• How to balance
• the tradition of individualism with the needs
  of
• Population health
• System outcomes
• Broader social needs
• Balance of equity and choice

• Changes needed
• Public understanding and expectation
• Legal framework
• Financing system
• Provider expectations
• Funded and deployed public system

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Its hard to be rural
Rural health care systems face many of the same
workforce issues as urban systems, with the
added challenge of being rural!

• Strategic Thinking
• Define Goals
• Short and Long Term
• Define measures of success

• Tactical Thinking
• Specific programs and policies
• Focus on strengths and collaborations

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Diversity Strategies
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DiversifyingShifting your Perspective

• Update your concept on future pools of workers,
  i.e., for nurses, pool may include allied health
  workers as well as young people
• Research on values and goals of new workers to
  understand how to recruit them into health
  careers
• Educators and employers work together to design
  work and learning environments that integrate
  these findings

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Workplace and Professions Changes

• Replicate the best of innovative approaches which
  have demonstrated success
• Mentoring, volunteering
• Develop career pathways across professions
• Focus on early and sustained education in health
  careers, flexible pathways
• Facilitate life-long learning

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Innovative Approaches

• LAUNCH (Learn about Unlimited New Careers in
  Healthcare)
• Provides K-12 students, teachers, and parents
  with age-appropriate information about the wide
  variety of health care occupations
• From basic statistics, to zany rap lyrics, there
  is something for everyone

• Project LINC (Ladders in Nursing Careers)
• A work/study program established by RWJ in 1988
• Participants receive full-time pay for part-time
  work while maintaining full-time enrollment in
  nursing education

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Innovative Approaches

• Health Care Integrated Education System, Arizona
• Acknowledged reality of a shared scope of
  practice among allied health and nursing
• Created a competency- based approach to training
• Three levels of training help students enter and
  exit in ways that meet their educational goals

• Health Career Educational Pathways
• HS restructure their academic program
• Form community partnerships
• Develop interdisciplinary curricula to prepare
  students for work or higher ed in health fields
• Students compete for academic scholarships

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California 21st CenturyWorkforce Project

• Phase 1
• An 18-month initiative, funded by the California
  HealthCare Foundation, to assess the allied and
  auxiliary health care workforce within the
  changing health care environment.
• Phase 2
• 3.1 million in funding for projects
  demonstrating innovative approaches to allied
  health workforce problems described in Phase One
  22 projects, in California, funded between
  27,000 and 200,000 for 18 months (selected from
  90 Letters of Intent to brochure and program
  announcements and 30 applications)
• Supported by The California Endowment and the
  California HealthCare Foundation

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What are the Key Allied Health Workforce Issues?

• Recruitment
• Education/Training
• Retention of Workers
• Diversity of Workforce
• Career Mobility

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The Worker Perspective

• Poorly defined job expectations
• Low pay, lack of benefits
• Inadequate training
• High rates of work-related injury
• Lack of opportunities for career advancement
• Lack of recognition
• The Hidden Health Care Workforce, 1999

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Allied Health Workforce Projects

• Located throughout California in urban and rural
  settings
• Project examples
• New models of learning e-learning, distance
  education, weekend programs
• Development of curricula for new workers
  mid-level lab technician, psychosocial rehab

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Allied Health Workforce Projects

• Recruitment of new populations of students
  bilingual rehab counselors, high-school students,
  community health workers
• Development of career pathways career mapping,
  on-site education and individualized career
  planning
• Recruitment and retention of students and
  workers CNAs, Psych techs, community clinic
  staff
• For complete project descriptions see the web
  site www.alliedhealthworkers.com What We Do

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Recruitment and Retention of Primary Care
Providers in Rural Areas

• Project Goals
• Assess rural communities success in recruiting
  and retaining primary care practitioners
• Primary Care Physicians
• Physician Assistants, Nurse Practitioners, etc
• Identify major strategies rural communities use
  to recruit and retain PCPs
• Suggest options for strengthening public policy
  in this arena

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Factors in Recruitment and Retention
Provider determinants

• Personal Characteristics
• gender
• race/ethnicity
• parents socioeconomic status
• home community
• expressed desire for service

• Practice Environment
• facilities
• reimbursements
• interactions with patients and colleagues
• schools
• job opportunities for spouses

Provider Challenges

• Community Involvement
• Work/Life Balance

• Professional Isolation
• Cooperation with
• Colleagues

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Rural Characteristics that Influence Choice of
Practice

• Presence of a hospital
• State-of-the-art facilities and equipment
• Telemedicine
• Leadership and Management
• Size of rural health care organizations
• Low/no penetration of managed care

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Recruitment and Retention Recommendations

• Overall Strategy
• View recruitment as an ongoing process
• Strive to find a good fit
• Honesty and frankness about challenges of the
  community
• Competitive compensation
• Administration involved in RR

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Recruitment and Retention Recommendations

• Overall Strategy
• Practitioner, board, and community members
  involved in recruitment
• Cognizance of the age/experience tradeoff
• For new grads, work with primary care residency
  programs, NP and PA programs

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Recruitment and Retention Recommendations

• Negotiation of Expectations
• Clear agreements about the type and amount of
  workload
• salary vs. workload
• flexibility
• administrative burden
• Clear expectations about hospital work
• inpatient vs. outpatient duties

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Recruitment and Retention Recommendations

• Infrastructure
• Stable governance and strong administrative
  leadership
• 24-hour coverage of ER
• Availability of specialists in community
• Strive to provide adequate housing

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Recommendations for Policymakers

• Incentives for practitioners
• Loan repayment
• Recruitment assistance
• web listings of vacancies
• Health professions education
• service-learning partnerships
• Reimbursement for health care services
• Payors pay telemedicine fees
• Infrastructure for health care delivery
• Telemedicine

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Increasing Health Workforce Supply in Underserved
Communities

• Success requires a comprehensive strategy
  composed of three major elements

Practice Environment Strategies
Medical Education Strategies
Applicant Pool Strategies
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Pharmacist Workforce

• Expansion of professional roles increase focus
  on quality of pharmaceutical care decreasing
  graduation rates shortage
• Solutions
• Use of technicians and application of automation
  and technology are first steps
• More training across pharm/tech programs for team
  care model
• Expand enrollment in schools
• Develop and implement a uniform prescription
  benefit card to relieve administrative burdens

DHHS The Pharmacist Workforce A study of the
supply and demand for Pharmacists December
2000, BHPr
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Rural Access to Oral Health Care

• Until recently, oral health care has not been on
  the national agenda
• There significant shortage of oral health
  services in rural communities
• Dental public health measures are not enough to
  stop the epidemic of oral diseases in children we
  are beginning to see
• The primary care system is not prepared to deal
  with oral health issues
• There are more barriers to obtaining dental care
  and fewer people have dental insurance than
  medical care or insurance

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The Oral Health Safety Net

• Community Dental Clinics
• Population Targeted Programs
• Mobile Dental Programs (2 types)
• School-Based / Linked Dental Programs
• Community Education and Outreach
• Case Management / Referral Programs
• Teledentistry
• Workforce Development / Dental Education
• State Financing and Funding
• Private Funding and Grant Programs
• Research and Information Collaboratives
• Community Water Fluoridation
• Interdisciplinary and Multidisciplinary Efforts

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The Oral Health Safety Net

• The common factors among these programs
• They expand services to populations who do not
  have access to the traditional private practice
  system
• They mediate the patient / provider relationship
  by addressing specific barriers at the consumer
  (demand), provider (supply), and system
  (institutional) level.
• There is no one solution, together they
  compromise the systems best effort at increasing
  access to care.

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Workforce Development
The current system does not have the capacity to
serve the underserved
Two Strategies 1) Increase the number of dentists
and allied dental professionals who will serve
underserved populations 2) Redefine the oral
health care workforce and expand roles of all
practitioners as appropriate

• Issues include
• Distribution and Composition
• Diversity
• Education / Training
• Competencies
• Expansion of roles

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Workforce Programs

• Recruitment, Retention, Training, Placement, CE
• Loan Repayment / Scholarships
• NHSC, CASLR, IHS, Local/Private
• Post-Bac Program
• Additional help for those without resources -
  financial and educational
• Education Partnership Programs
• Track interested students from primary on up
• Service Learning
• Educational Partnership Agreement Dental Pilot
  Initiative (NHSC)
• ABCD Program
• Training component teaches new skills for
  practicing dental professionals

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Redefining the Oral Health Care Workforce

• Interdisciplinary models for
• care delivery exist
• Expand roles of non-oral health professionals to
  assist in prevention, referrals and oral health
  education
• Easiest to reach underserved populations in
  existing settings (primary care clinics, WIC
  offices, schools)
• Many barriers as professional boundaries and
  traditional modes of practice are change averse

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Strategic Directions

• Objective
• Long term strategy
• Rationale
• Action Steps
• Consumer
• Provider
• System
• Partners
• Level of Implementation
• Cost / Funding
• Measurement

Values and changes
Short term, enabling strategies
Who needs to be involved
Good plans get the funding
Effective programs new models
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Future Directions

• Scramble
• Buy more workers, threaten action, study the
  issue, 4 color brochures and ads, sign-on
  bonuses, debate the problem
• Improve existing processes to fit todays
  challenges
• Adjust education, improve management, engage
  workers in problem solving, collaborate, fund
  tuition scholarships, distance learning, mentor
  programs

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Future Directions

• Reinvent the fundamental properties of work,
  education, and professional organization
• Experiment with new models, diversify, lower the
  wall between education and work/practice,
  integrate
• Start Over
• Community integration, collaborative
  partnerships, new care delivery models based on
  patient needs and wants, new professional and
  practice models, cultural competency, technology
  adoption
• ACT!

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Publications and Resourceshttp//futurehealth.ucs
f.edu

• Recruitment and Retention of Primary Care
  Providers in Rural California (upcoming)
• Strategies for Diversifying the Health Care
  Workforce (upcoming)
• Diversifying the Nursing Workforce A California
  Imperative (2001)
• Improving Oral Health Care Systems in California
  (2000)
• The Hidden Health Care Workforce Recognizing,
  Understanding and Improving the Allied and
  Auxiliary Health Care Workforce (1999)
• Strategies for Increasing Physician Supply in
  Medically Underserved Communities in California
  (1999)

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3333 California Street, Suite 410 San Francisco,
CA 94118 [phone] / (415)
476-4113 http\\futurehealth.ucsf.edu