WorkforcePlanninginaRapidlyChangingHealthcareSystem

ErinFraher,PhDMPPDirector,CarolinaCenterforHealthWorkforceResearch,

CecilG.ShepsCenterforHealthServicesResearch,AssistantProfessor,DepartmentsofFamilyMedicineandSurgery,

UniversityofNorthCarolinaatChapelHill

SouthCarolinaHealthCareWorkforceForumFebruary13,2017

Disclaimer/NoConflictofInterest

•  MyworkissupportedbytheNa4onalCenterforHealthWorkforceAnalysis(NCHWA),HealthResourcesandServicesAdministra4on(HRSA)undercoopera4veagreement#U81HP26495,TheRobertWoodJohnsonFounda4onandThePhysiciansFounda4on.

•  Theinforma4on,conclusionsandopinionsexpressedinthispresenta4onaremineandnoendorsementbythefundersorTheUniversityofNorthCarolinaisintendedorshouldbeinferred.

•  Ideclarenoconflictofinterest.

ThispresentaKoninoneslide

•  Currentsystemisnotsustainable—costpressureswilldrivechange

•  Increasedemphasisonpopula4onhealthrequiresexpandeddefini4onofhealthworkforce

•  Nursingworkforceiscri4caltotransforma4on.NeedtoshiYdialoguefromnumberstoretooling

•  Di[oforphysicians—bigissueismaldistribu4onbyspecialtyandgeography

•  Workforceplanningforrapidlychanginghealthcaresystemrequiresbe[erconnec4onsbetweeneduca4onandprac4ceandamoreflexibleworkforce

ForcesDrivingChange

Whydowecareaboutthehealthworkforce?

•  Workforceisexpensive:of$2.6trillionspentonhealthcare,56%a[ributedtowages*

•  Expensiveandinefficienttolurchfromoversupplytoshortage

*DunnL.GeWngaHandleonHospitalCosts.HospitalsandHealthNetworks.2015

Needstrategicworkforceplanningto“smooth”thecycle

time

supp

ly

Typical intervention point

Ideal intervention point

Supply of health professionals

LetOneThousandFlowersBloom:Experimentstoreformhealthsystem

•  Withorwithouthealthreform,costpressuresaredrivingchange

•  Newmodelsofcareaimtolowercosts,enhancequality,improvepopula4onhealthandlowerproviderburnout–  Pa4entCenteredMedicalHomes

–  AccountableCareOrganiza4ons–  ClinicallyIntegratedNetworks

WhatarethekeycharacterisKcsofnewmodelsofcare?

ProvidepaKentswithmorecomprehensive,accessible,coordinatedandhighqualitycareatlowercosts

•  Emphasisonprimary,preven4veand“upstream”care

•  Careisintegratedbetween:–  Primarycare,subspecial4es,homehealthagenciesandnursinghomes

–  Healthcaresystemandcommunity-basedsocialservices

•  EHRsusedtomonitorpa4entandpopula4onhealth—increaseduseofdataforriskstra4fica4onandhotspofng

•  Interven4onsfocusedatbothpa4ent-andpopula4on-level•  Movetowardrisk-basedandvalue-basedpaymentmodels(maybe?)

Differenthealthsystemmeansdifferentworkers

“Atransformedhealthcaresystemwillrequireatransformedworkforce.

ThepeoplewhowillsupporthealthsystemtransformaIonforcommuniIesand

populaIonswillrequiredifferentknowledgeandskills…inprevenIon,carecoordinaIon,careprocessre-engineering,disseminaIonofbestpracIces,team-basedcare,conInuousqualityimprovement,andtheuseofdatatosupporta

transformedsystem.”

Source:CentersforMedicareandMedicaidServices,HealthCareInnovaKonChallengeGrant,FundingOpportunityNumber:CMS-1C1-12-001,CFDA:93.610,November2011.hcp://www.innovaKons.cms.gov/Files/x/Health-Care-InnovaKon-Challenge-Funding-Opportunity-Announcement.pdf

AHealthWorkforceoraWorkforceforHealth?

Whoisthrowingbodiesintotheriver?

“IamstandingbytheshoreofaswiYlyflowingriverandhearthecryofadrowningman.Ijumpintothecoldwaters.Ifightagainstthestrongcurrentandforcemywaytothestrugglingman…Ilayhimoutonthebankandrevivehimwithar4ficialrespira4on.Justwhenhebeginstobreathe,Ihearanothercryforhelp…Ifightagainstthestrongcurrent,andswimforcefullytothestrugglingwoman…IliYheroutontothebankbesidethemanandworktoreviveherwithar4ficialrespira4on.Justwhenshebeginstobreathe,Ihearanothercryforhelp….Nearexhaus9on,itoccurstomethatI'msobusyjumpingin,pullingthemtoshore,applyingar9ficialrespira9onthatIhaveno9metoseewhoisupstreampushingthemallin....”(AdaptedfromastorytoldbyIrvingZolaascitedinMcKinlay,JohnB."Acaseforrefocusingupstream:Thepoli4caleconomyofillness."InConradandKern,2ndedi4on,1986,TheSociologyofHealthandIllness:CriIcalPerspecIves.pp.484-498.)

ThisistheaimofAccountableHealthCommuniKesModelannouncedbyCMS“Werecognizethatkeepingpeoplehealthyisaboutmorethanhappensinsideadoctor’soffice…wearetesIngwhetherscreeningpaIentsforhealth-relatedsocialneedsandconnecIngthemtolocalresourceslikehousingandtransportaIontothedoctorwillulImatelyimprovetheirhealthandreducecoststotaxpayers…”SecretaryBurwell,h[p://www.hhs.gov/about/news/2016/01/05/first-ever-cms-innova4on-center-pilot-project-test-improving-pa4ents-health.html

AccountableHealthCommuniKesGoalsandAims

“ThefoundaIonofthemodelisuniversal,comprehensivescreeningforhealth-relatedsocial

needs—includinghousingneeds,foodinsecurity,uIlityneeds,interpersonalsafetyandtransportaIon

difficulIes—inallMedicareandMedicaidbeneficiarieswhoobtainhealthcareatparIcipaIngsites”

Alley,DE,AsomughaCN,ConwayPH,SanghaviDM.(2016).AccountableHealthCommuni4es—AssessingSocialNeedsthroughMedicareandMedicaid.NewEnglandJournalofMedicine.371;1:8-11.

SuchanapproachrequiresbroaderdefiniKonofthehealthworkforce

PopulaKonhealthrequiresusto:

•  Expandworkforceplanningeffortstoincludeworkersincommunityandhome-basedsefngs

•  Embracetheroleofsocialworkers,pa4entnavigators,communityhealthworkers,homehealthworkers,communityparamedics,die4ciansandothercommunity-basedworkers

•  Planforworkforceneedsofpa4entsandcommuni4es,notforneedsofprofessions

•  Determinehowtointegratethepublichealthworkforceintohealthworkforceplanning

Wheredoesthepublichealthworkforcefitin?

•  “PublicHealth3.0”(Oct2016)callsfor“neweraofenhancedandbroadenedpublichealthprac4cethatgoesbeyondtradi4onalpublichealthdepartmentfunc4ons”

•  Howwillpublichealthmaintaintradi4onalstrengthsandconfrontchallengesofagingpopula4onwithchronicdisease?

•  “Health-in-all-policies”arereshapinginterfacebetweenpublichealthandcommunitypartners

•  PublicHealth3.0callsfora“ChiefHealthStrategist”todevelopcommunitypartnerships

•  Thosepartnersincludehospitalsandphysicianprac4ces

Source:OfficeoftheAssistantSecretaryforHealth,USDepartmentofHealthandHumanServices.ACalltoAcKontoCreatea21stCenturyPublicHealthInfrastructure.Washington,DC.October2016.hcps://www.healthypeople.gov/sites/default/files/Public-Health-3.0-White-Paper.pdf

IntegraKngpublichealthandhealthworkforceplanning

•  RecentsurveybyNa4onalAssocia4onofCountyandCityHealthOfficials(NACCHO)foundthat58%oflocalhealthdepartmentswerecollabora4ngwithhospitalsoncommunityhealthneedsassessments

•  ButareCHNAsbeingusedforworkforceplanning?•  Surveyiden4fiedskillgapsininforma4cs

•  Publichealthworkforceofthefuturewillincreasinglyneedtouse“bigdata”forsurveillance,assessmentandevalua4on(andworkforceplanning!)

Source:NACCHO.2016NaKonalProfileofLocalHealthDepartments.WashingtonDC.hcp://nacchoprofilestudy.org/wp-content/uploads/2017/01/Main-Report-Final.pdf.

Boundaryspanningrolesgrowingquickly

PanelManagers HealthCoaches

Assumeresponsibilityforpa4entsbetweenvisits.UseEHRsandpa4entregistriestoiden4fyandcontactpa4entswithunmet

careneeds.OYenmedicalassistantsbutcanbenursesor

otherstaff

Improvepa4entknowledgeaboutdiseaseormedica4onandpromotehealthybehaviors.Maybemedicalassistants,nurses,

healtheducators,socialworkers,communityhealthworkers,pharmacistsorotherstaff

“Boundaryspanning”rolesreflectshiYfromvisit-basedtopopula4on-basedstrategies

Twoexamples:

Othernewrolesareemerginginevolvingsystem

•  Pa4entnavigators•  Casemanagers•  Carecoordinators•  Communityhealthworkers•  Caretransi4onspecialists•  Livingskillsspecialists•  Pa4entfamilyac4vator•  Peerandfamilymentors•  Peercounselors

Ø  Allplayroleinpa4enttransi4onsbetweenhome,community,ambulatoryandacutecarehealthsefngs

Ø  Evidenceshowsimprovedcaretransi4onsreduceunnecessaryhospitaladmissions,lowercostsandimprovepa4entsa4sfac4on

EmergingRoles ImplicaKons

It’scomplicated

•  Newrolesmaybefilledbyexis4ngstaffornewhires

•  Someroleshavesimilarfunc4onsbutdifferent4tles—caremanagersandcasemanagers

•  Otherroleshavedifferentfunc4onsbutsamename—paKentnavigators

•  Dependingonsefngandpa4entpopula4on,rolesareoYenfilledbydifferenttypesofproviders—medicalassistants,socialworkers,nurses,etc.

Socialworkersplayincreasinglyimportantboundaryspanningroles

SocialworkersservingthreefuncKonsonintegratedbehavioralhealth/physicalhealthteams:

•  Behavioralhealthspecialists:provideinterven4onsforpa4entswithmentalhealth,substanceabuseandotherbehavioralhealthdisorders

•  CareManagers:coordinatecareofpa4entswithchroniccondi4ons,monitorcareplans,assesstreatmentprogressandconsultwithprimarycarephysicians

•  Referralrole:connectpa4entstocommunityresourcesincludinghousing,transporta4on,food,etc.

Fraser M, Lombardi B, Wu S, Zerden L, Richman E, Fraher E. Social Work in Integrated Primary Care: A Systematic Review. Program on Health Workforce Research and Policy, Cecil G. Sheps Center for Health Services Research. September 2016. http://www.shepscenter.unc.edu/wp-content/uploads/2016/12/PolicyBrief_Fraser_y3_final.pdf

Andnewhealthcareteamsareemerging:CommunityAginginPlace—AdvancingBecerLivingforElders(CAPABLE)Teams

•  AnOccupa4onalTherapist,aRegisteredNurse,andahandymanformteamallowingseniorstoageinhomes

•  Provideassis4vedevicesandmakehomemodifica4onstoenablepar4cipantstonavigatetheirhomesmoreeasilyandsafely

•  AYercomple4ngfive-monthprogram,75percentofpar4cipants(n=281adultsage65+)hadimprovedtheirperformanceofADLs

•  SymptomsofdepressionandabilitytoperforminstrumentalADLssuchasshoppingandmanagingmedica4onsalsoimproved

•  Healthsystemsaretes4ngCAPABLEonalargerscale

h[p://nursing.jhu.edu/faculty_research/research/projects/capable/

Source: Szanton SL, Leff B, Wolff JL, Robers K, Gitlin LN. (2016). Home-Based Care Program Reduces Disability And Promotes Aging In Place. Health Affairs; Sep 1;35(9):1558-63.

Wheredoesnursingfitin?Willwefaceanursingshortage?

Shortage?Noshortage?Dowereallyknow?

•  Na4onalnursingmodelsmixed:somesuggestshortage,othersexcesssupply

•  Evenrecently,graduatesinstatespredictedtobeinshortagewerenotgefngtheirfirst,orevensecond,employmentchoice

•  HRSAprojectsSouthCarolinawillbasicallybeinbalancein2025(600nursesshortonbasesupplyof54,000)

•  Doesthisprojec4on“feelright”?

NumberofnewNCLEXtakersincreasingrapidly

Between2001-2011:•  Numberofbachelor’s

preparedRNcandidatestakingtheNCLEX-RNexammorethandoubled

•  AssociatedegreecandidatestakingtheNCLEX-RNexamexperienceda99%growth

Figure19:GrowthinNCLEX-RNFirst-TimeTestTakers,byBachelor’sandNon-Bachelor’sDegreeStatus,2001to2011

DataSources:HRSAcompila4onofdatafromtheNa4onalCouncilofStateBoardsofNursing,NurseLicensureandNCLEXExamina4onSta4s4csPublica4ons,2002-2012,andfromtheNa4onalCouncilofStateBoardofNursing,“NumberofCandidatesTakingtheNCLEXExamina4onandPercentPassing,byTypeofCandidate,”h[ps://www.ncsbn.org/Table_of_Pass_Rates_2011.pdf

Source:Na4onalCenterforHealthWorkforceAnalysis,HRSA,h[p://bhpr.hrsa.gov/healthworkforce/supplydemand/nursing/nursingworkforce/nursingworkforcefullreport.pdf,pgs37-38,accessed11/5/15.

Butontheground,we’rehearingaboutnursingshortages.Why?

Coulditbethatourmodelsarenotaccurate(GASP!)?

•  Wemodeloverallsupplyandnotsupply/demandinspecificprac4ceareaslikeICU,ER,L&DandOR–  Arethereshortagesforspecialtynurses?

•  Re4rementassump4onshaveLARGEeffectonmodels.Maybeourmodelsdon’thaveit“right”?

–  Arebabyboomersnowbeginningtore4reinlargernumbers?

Maybewe’renotmodelingdemandcorrectly?

•  Demandmaybeupduetoabe[ereconomy,increasedinsurancecoverageandagingpopula4on

•  Demandhasincreasedinoutpa4entsefngsandinpa4entnursing-whichhasalwaysbeenpopular-isnowcompe4ngwithothersefngs

Maybethereisamismatchbetweenwhateducatorsproduceandemployerswant?

•  Hospitalswantexperiencednursesandarenothiringnewgradsbecausetheyarenotgradua4ngwiththeclinicalexper4sethathospitalswant

•  Healthsystemsareseekingnursesfornewrolesinpa4entengagement,carecoordina4on,informa4csandotherfunc4onsinnewmodelsofcare(moreonthatlater….)

AcriKonseemstobeontherise,FTEonthedecline

•  A[ri4onofnewnursesseemstobeincreasing.Why?

•  BSNsarenotstayingtheworkforce—theywanttobecomeadvancedprac4cenursesandareleavingtheworkforcetogobackschool

•  Millennialsdon’twanttoworkasmanyhoursandarenottakingonextrashiYs

Otherreasonswhyourmodelsmaynotbecorrect

•  Hiringinterna4onallytrainednurseshasbecomemoredifficult

•  Paymentmodelsarechanging—maybevalue-basedpaymentmodelsemploymorenurses?

•  Other?

Butlet’sshilthedialogue

Focusingonwhetherwehaveanursingshortagedistractsusfromamoreimportantques4on:

Willwehavetherightmixofnursesinthe

rightloca9ons,special9esandprac9ceseCngs

withtheskillsandcompetenciesneededtomeet

thedemandsofatransformedhealthcaresystem?

Thefuturenursingworkforce:Newrolesinatransformed

healthsystem

WhythenursingworkforceiscriKcaltohealthsystemtransformaKon

•  Withnearly3millionnursesinac4veprac4ce,nursingisbyfarthelargestlicensedhealthprofession(aboutfourImesasmanynursesasphysicians)

•  Nursingcarelinkedtoqualityandsa4sfac4onmeasuresthatwillincreasinglybe4edtovalue-basedpayments

•  Nursesprovidewhole-personcareacrosshealthandcommunity-basedsefngs

•  Nursesaretheul4mate“flexible”workforcetakingonnewrolesintransformedhealthsystem

WorkforceisshilingfromacutetocommunityseWngs

•  Changesinpaymentpolicyandhealthsystemorganiza4on:–  ShiYfromfee-for-servicetowardrisk-andvalue-basedmodels–  Finesthatpenalizehospitalsforreadmissions

•  WillincreasinglyshiYhealthcare—andthehealthcareworkforce—fromexpensiveinpa4entsefngstoambulatory,communityandhome-basedsefngs

•  Butwegenerallyeducatenursesininpa4entsefngs

•  Currentworkforcenotadequatelypreparedtoworkinambulatorysefngsandpa4ents’homes

WhiletheoverallpercentofSouthCarolinanursesemployedinhospitalshasn’tchanged

Source: SC Office for Healthcare Workforce, RNs active in the South Carolina workforce based on self-reported employment information provided during the biennial license renewal period, years 2004 – 2014.

ThepercentworkinginpaKenthasdecreased,andpercentin“hospital-wide”roleshasincreased

Source: SC Office for Healthcare Workforce, RNs active in the South Carolina workforce based on self-reported employment information provided during the biennial license renewal period, years 2004 – 2014.

Nursingworkforce:Newroles,newrules

Cita4on:FraherE,SpetzJ,NaylorM.NursinginaTransformedHealthCareSystem:NewRoles,NewRules.LDI/INQRIResearchBrief.June2015.h[p://ldi.upenn.edu/uploads/media_items/inqri-ldi-brief-nursing.original.pdf.

“Whatwillittaketoop9mizecontribu9onsofnurses?• Redesignthenursingcurriculumtoeducatenurseswithnewcompetencies;• RetrainexisIngnurseswithnewskillsandknowledge;• RevamplicensingexaminaIonandrequirementstoreflectthenewcurriculum;and• Restructurethestateregulatorysystemtoallowflexibledeploymentofthenurseworkforce.”

h[p://www.shepscenter.unc.edu/wp-content/uploads/2015/07/inqri-ldi-brief-nursing.original.pdf-QuotedfromJanetWeiner,MPH.PennLDIVoicesBlog.“Re:Nurses”.

June25,2015.hep://ldi.upenn.edu/voices/2015/06/25/re-nurses

RegisteredNursesareunderuKlizedinprimarycare

1.  CulturechangeneededtoelevateprimarycareinRNeduca4on

2.  Prac4cesshouldredesigncaredeliverymodelstobe[eru4lizeRNskills

3.  Educatorsneedtoputmoreemphasisonprimarycarecontent

4.  Lifelonglearningopportuni4esneededtosupportRNsinprimarycare

5.  Be[eralignmentneededbetweenRNeduca4onandprac4ce

6.  Moreinterprofessionaleduca4onandteamworkneededincurricula

h[p://macyfounda4on.org/docs/macy_pubs/201609_Nursing_Conference_Exectuive_

Summary_Final.pdf

PhysicianWorkforceIssues&GraduateMedicalEducaKon

ExpertsdisagreeaboutwhethertheUnitedStateswillfaceashortage

•  AAMCprojectsshor�allsofbetween12,500and31,000primarycarephysiciansand46,100and90,400totalphysiciansby20251

•  Federalgovernment(HRSA)forecastsshortageof6,400primarycarephysiciansin20202withincreaseduseofNPsandPAs

•  WereleasedmodelinJuly2014thatsuggestsoverallsupplywillbeadequate,morepressingissueismaldistribu4onbyspecialtyandgeography

1 AAMC, https://www.aamc.org/download/426242/data/ihsreportdownload.pdf?cm_mmc=AAMC-_-ScientificAffairs-_-PDF-_-ihsreport 2 HRSA, http://bhpr.hrsa.gov/healthworkforce/supplydemand/usworkforce/primarycare/projectingprimarycare.pdf

h[ps://www2.shepscenter.unc.edu/workforce

This project is funded by a grant from The Physicians Foundation.

OurmodelhighlightsthatweareanaKonof“haves”and“have-nots”

Shortage/Surplus for All Visits, All Settings, 2014 Aurora,IL

NewOrleans,LA

Washington,DC

Boston,MA

NewYork,NY

SanFrancisco,CA

Slidell,LA

Rochester,MN

Boulder,CO

HunIngton,WV

Bangor,ME

MelrosePark,IL

This project is funded by a grant from The Physicians Foundation.

AndthatexpectedgrowthinNPsandPAswilloffsetphysicianshortages

NP/PA Increase by 3%

Baseline

NP/PA Increase by 6%

42

* Counts include master’s and post-master’s NP and NP/CNS graduates, and Baccalaureate-to-DNP graduates. Source: American Association of Colleges of Nursing (AACN) and National Organization of Nurse Practitioner Faculties (NONPF) Annual Surveys

Gra

duat

es

GrowthinNursePracKKonerGraduates*2001-2015

Growth from 2014 to 2015 : 20.3%

This project is funded by a grant from The Physicians Foundation.

ForSC,ourmodelforecastsstableoverallsupplybutdecliningsupplyinprimarycare

PrimaryCareAllspecial9es

13.1 13.5 6.0 4.9

PhysicianSupply,FTEper10,000PopulaKon,SouthCarolina,2013-2030

h[ps://www2.shepscenter.unc.edu/workforce

This project is funded by a grant from The Physicians Foundation.

SouthCarolinalikelytofaceexcessdemandforhealthcarevisits

= supply of visits physicians can provide utilization of visits needed by population

h[ps://www2.shepscenter.unc.edu/workforce

RelaKveCapacityofPhysicianSupplytoMeetDemandforVisits,SouthCarolina,2013-2030

This project is funded by a grant from The Physicians Foundation.

WhatifweactuallyusedworkforcedatatodeterminewheretoinvestinGME?Weusedmodeltodeterminehowtotargetproposed3,000PGY1slotstomeetan4cipatedshortagesn  FindingssuggestexpandingGMEinstateswith:

q  Poorhealthoutcomesandhighhealthcareu4liza4on(Arkansas,MississippiandAlabama)

q  Large,growingpopula4ons(TexasandCalifornia)q  Agingpopula4ons(Florida)q  Lowresident/popula4onnumbers(Idaho,Wyoming,Montana,

AlaskaandNevada)n  5states(Connec4cut,Delaware,NewHampshire,RhodeIslandand

Vermont)andtheDistrictofColombiareceivenoGMEslotsbecausetheyarealreadywellsupplied

SouthCarolinawouldreceive64newPGY1posiKons

Specialty Cardiology 6 Dermatology 2 Emergency Medicine 3 Family Medicine 6 Gastroenterology 3 General Pediatrics 3 Gynecology/Obstetrics 2 Infectious disease 4 Internal Medicine 9 Nephrology 2

Modelproposes64newPGY1posiKonsinSouthCarolina

Specialty Oncology 5 Other Physician Specialty 2

Pediatric Non-Surgical Specialties

3

Plastic Surgery 2 Psychiatry 2 Pulmonology 2 Surgery 4

Thoracic Surgery 2

Urology 2 New PGY1 Slots 64

# PGY1 Slots # PGY1 Slots

Werecentlycompletedstudyoftenstates’effortstoreformMedicaidGMEWhystudystates?

• FederalGMEreformeffortshavestalled

• Statesare“policylaboratories”forGMEinnova4on

• Manystatesinves4nginGMEwithMedicaiddollars:

–  In2015,43statesandDCmadeMedicaidGMEpayments

–  TotalMedicaidGMEpaymentsincreased10%from$3.87billionin2012to$4.26billionin2015

h[p://www.shepscenter.unc.edu/programs-projects/workforce/projects/carolina-health-workforce-research-center/

StudyisKmely

•  Withchangeoffederaladministra4on,policywindowmaybeopeningforincreasedstateinvolvementinGME

•  Poten4alforMedicaidblockgrantsorpercapitaallotmentscouldacceleratestate-levelGMEreform

•  Statesfacingbudgetconstraintsandpressuretoiden4fyreturnoninvestmentforpublicfundsspentonGME

•  Thisstudysoughtto:–  Inves4gatehowstatesarereformingMedicaidandstate-fundedGMEfinancing

–  Iden4fyinnova4onsandchallenges

Whatwefound

•  Highlevelofinterest,limitedreformofMedicaidGME

•  MoststatesseekingnewGMEappropria4ons,notredistribu4ngexis4ngfunds

•  Oversightbodiesplaycri4calroleineduca4nglegislatureandnaviga4ngcompe4ngGMEinterests

•  Weheardloudcallforincreasedaccountability/transparency

•  Cri4calneedforbe[erdataandmetricstomeasureworkforceoutcomesofresidencytraining

h[p://www.shepscenter.unc.edu/programs-projects/workforce/projects/carolina-health-workforce-research-center/

Workforceplanningthefuture:Howdowegettherefromhere?

It’snotjustaboutretoolingtheworkforce.Weneedtoretoolthesystemthatsupportstheworkforce:educa4on,prac4ceandregula4onneedstobemoreresponsivetochangesinfront-linehealthcaredelivery

WeneedtobecerconnecteducaKontopracKce

“RevoluIonarychangesinthenatureandformofhealthcaredeliveryarereverberaIngbackwardinto…

educaIonasleadersofthenewpracIceorganizaIonsdemandthattheeducaIonalmissionberesponsivetotheirneedsforpracIIonerswhocanworkwithteamsinmoreflexibleand

changingorganizaIons…”

• Buteduca4onsystemislaggingbecauseitremainslargelyinsulatedfromcaredeliveryreform

• Needcloserlinkagesbetweenhealthcaredeliveryandeduca4onsystems

Source:RickecsT,FraherE.ReconfiguringhealthworkforcepolicysothateducaKon,training,andactualdeliveryofcarearecloselyconnected.HealthAff(Millwood).2013Nov;32(11):1874-80.

OnpracKceside:redesignhumanresourceinfrastructuretosupportnewroles

•  Needtominimizeroleconfusionbyclearlydefiningandtrainingfornewfunc4ons

•  Jobdescrip4onshavetoberewri[enorcreated

•  Workflowshavetoberedesigned

•  Lackofstandardizedtrainingandfundstosupporttrainingisbigobstacle

•  Exis4ngstaffwon’tdelegateorsharerolesifdon’ttrustotherstaffmembersarecompetent

•  Timespenttrainingisnotspentonbillableservices

Howdoweredesignstructurestosupportnewroles?EducaKon

•  Retrainandupgradeskillsofthe18millionhealthcareworkersalreadyinthesystem–theyaretheoneswhowilltransformcare

•  Trainingmustbeconvenient–4ming,loca4on,andfinancialincen4vesmustbetakenintoconsidera4on

•  Needtopreparefacultytoteachnewrolesandfunc4ons

•  Clinicalrota4onsneedtoinclude“purposefulexposure”tohigh-performingteamsinambulatorysefngs

•  Needtoredesigneduca4onsystemsoworkforcecanflexiblygainnewskillsandcompetenciesthroughoutcareer

Source:FraherE,SpetzJ,NaylorM.NursinginaTransformedHealthCareSystem:NewRoles,NewRules.LDI/INQRIResearchBrief.June2015;Laddenetal.TheEmergingPrimaryCareWorkforce.PreliminaryObserva4onsfromthePrimaryCareTeam:LearningfromEffec4veAmbulatoryPrac4cesProject”.AcademicMedicine;1013,88(12):1830-1835.

Goal:flexibleworkforcethatcanadapttorapidlychanginghealthcaresystem

Bothnewentrantstotheworkforce

Andour“seasonedworkers”

“The workforce innova4ons needed to implement ACA programs require an adaptable regulatory system capable of evolving with the health care environment. The health profession regula4on system in place today

does not have the flexibility to support change

Howdoweredesignstructurestosupportnewroles?RegulaKon

Tocreateamoredynamicregulatorysystem,weneedto:•  developevidencetosupportregulatorychanges,especiallyfornewroles•  evaluatenew/expandedrolestounderstandifinterven4onsimprovehealth,

lowercostsandenhancesa4sfac4on•  removeregulatorybarrierstoletworkforceu4lizeskillstomaxbenefit

ofpa4ents

Source:DowerC,MooreJ,LangelierM.Itis4metorestructurehealthprofessionsscope-of-prac4ceregula4onstoremovebarrierstocare.HealthAff(Millwood).2013Nov;32(11);FraherE,SpetzJ,NaylorM.NursinginaTransformedHealthCareSystem:NewRoles,NewRules.LDI/INQRIResearchBrief.June2015.

HealthWorkforcePlanningtheTradiKonalWay

WeneedtobelikeWayneGretsky

….but how do we know where the

puck is going to be?

“Iskatetowherethepuckisgoingtobe,nottowhereithasbeen.”−WayneGretsky

Contactinfo

ProgramonHealthWorkforceResearchandPolicyhcp://www.healthworkforce.unc.edu

ErinFrahererin_fraher@unc.edu

(919)966-5012