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PubMedDate not supplied

Building a home healthcare workforce to meet the quality imperative.

The 1990s brought shifts in the organization and financing of healthcare services and changes to the nursing workforce as well. These changes were pronounced in home healthcare, where growth in service use between 1988 and 1996 was followed by sharp contractions in home healthcare users and visits after changes in Medicare reimbursement policy in 1997. This article examines how the nursing workforce has responded to these changes, explores the challenges posed by the nursing shortage, highlights the gap in knowledge of the staffing-outcomes relationship and its implications for quality, and offers recommendations on ways to improve care.

Ambulatory Care↗
PubMed2001

A conceptual model for leadership development.

Collaboration among schools of public health and national, state, and local health agencies has resulted in creation of comprehensive public health workforce education and training initiatives that offer integrated, sequential, and accessible professional development programs, including a nation-wide network of public health leadership institutes. A conceptual model for leadership development is presented. It contains seven elements considered critical for design of leadership programs in public health: capacity/competence needs; program target; area served; program content; training level; learning approach; and implementation methods. This model can be used to design leadership as well as public health workforce education and training programs.

Cooperative Behavior↗
PubMed2006

Postgraduate medical placements in rural areas: their impact on the rural medical workforce.

INTRODUCTION: In 1988, the New South Wales (NSW) Department of Health developed the NSW Rural Resident Medical Officer Cadetship Program (Cadetship Program) to help overcome a junior doctor workforce shortage in rural hospitals. A second aim was to increase recruitment to the rural medical workforce on the basis that positive exposure to rural medicine increases the likelihood of choosing to practice in a rural location. The Cadetship Program offers bonded scholarships which provide financial support for residents of NSW studying medicine during the final 2 years of their medical degree. In return, cadets are contracted to complete 2 of their first 3 postgraduate years in the NSW rural hospital network. NSW Rural Doctors Network has managed the Cadetship Program for the NSW Department of Health since 1993, and carried out an evaluation in 2004. The purpose of this evaluation was to track the career choice and practice location of medical students entering the Cadetship Program before 1999, and to comment on the impact of the Program on the rural medical workforce in NSW to date, and its implications for the future workforce. METHODS: The career choice and practice locations of 107 medical students who received cadetships between 1989 and 1998 were tracked. Students who did not graduate from medical school (n = 3) or who did not complete their rural service (13) were excluded from the analysis. Career choice was not available for a further nine former cadets and they were also excluded from the analysis. The NSW Rural Doctors Network was the major source of data on career choice and practice location due to its role in administering the Cadetship Program on behalf of the NSW Department of Health. Two brief questionnaires targeting specific groups of cadets were used to fill knowledge gaps about where cadets grew up, what vocational training they undertook, and where they were working in 2004. Where this information was not obtained from cadets first hand, it was sourced from the CD-ROM version of the Medical Directory of Australia. RESULTS: Forty-three percent of cadets entering the Program before 1999 were working in rural locations in 2004 (compared with 20.5% of medical practitioners nationally), 46% had attended primary school in a rural location and 44% chose to specialize in general practice. Career choice was the major determinant of practice location. Having a rural background did not appear to influence practice location; whereas, those specialising in general practice made up 70% of this cohort of cadets working in rural areas. All general practice trainees were in rural locations compared with only two of the 25 trainee specialists, which reflects the availability of accredited training places in rural Australia. CONCLUSIONS: The Cadetship Program, which ensures junior doctors work for 2 of their first 3 postgraduate years in a rural allocation centre, is an effective link between medical school and rural practice, particularly rural general practice. Providing vocational training opportunities in rural locations is central to this success, and needs to be considered in efforts to expand the rural specialist workforce, and in ensuring rural health capitalises on the increasing number of medical students moving through the education and training system in the next 4-10 years.

Career Choice↗
PubMed1995

Creating a culturally competent workforce.

Culturally sensitive health care professionals will have a distinct advantage in the 21st century. As the United States continues to grow as a multicultural society, practitioners will require access to cultural diversity training tailored to the needs of health care providers. The American Occupational Therapy Association offers an array of such educational resources through its Multicultural Affairs Program.

Allied Health Personnel↗
PubMed1997

Recruitment, retention, and time commitment change of general practitioners in England and Wales, 1990-4: a retrospective study.

OBJECTIVES: To describe the recruitment and retention of general practitioners and changes in their time commitment from 1 October 1990 to 1 October 1994. DESIGN: Retrospective analysis of yearly data. SETTING: England and Wales. SUBJECTS: General practitioners in unrestricted practice. MAIN OUTCOME MEASURES: Numbers of general practitioners moving into and out of general practice; proportion of general practitioners practising less than full time; proportion of general practitioners having unchanged time commitment over the study period; and proportion of general practitioners leaving general practice in 1991 who were subsequently practising in 1994. RESULTS: Numbers of general practitioners entering general practice (1565 in 1990, 1400 in 1994) fell over the study period as did the numbers leaving general practice (1488 in 1990, 1115 in 1994). The net effect was an increase in both the total and full time equivalent general practitioners practising from 1 October 1990 (26,757 full time equivalents) to 1 October 1994 (27,063 full time equivalents). Numbers of general practitioners practising full time were decreasing whereas part time practice was increasing; women were more likely to practise part time. 35.5% (43/121) of women practising full time and 17.8% (24/135) of men practising full time who left practice in 1991 were practising again in 1994. CONCLUSION: Simply using total numbers of general practitioners or net increase to describe workforce trends masks much movement in and out of general practice and between differing time commitments. Recruitment and retention issues need to be separated if reasonable policies are to be developed to assure the necessary general practitioner workforce for a primary care led NHS.

Adult↗
PubMed1990

Strategic planning for training: how to manage the competence of your workforce.

Peak performance in today's challenging business environment requires systematic management of workforce competencies. The strategic planning approach to training offers a systematic method for defining the competency requirements of the workforce; devising plans, policies and strategies for developing these competencies; allocating resources; and implementing a performance-based training system. The strategic training plan is a vehicle for putting management in control of the competence of the workforce by gaining control of the training system.

Competency-Based Education↗
PubMed2006

Cultural competency: Agenda for Cultural Competency Using Literature and Evidence.

BACKGROUND: Cultural competency has been recognized as an important issue relevant to all health professions. A research agenda is needed to establish a systematic approach to developing an understanding of factors relevant to the delivery of culturally competent health care. OBJECTIVE: Within the context of existing literature, evidence-based, concrete recommendations are developed as an Agenda for Cultural Competency Using Literature and Evidence (ACCULTURE). METHODS: First, key points representing opportunities for intervening in promotion of cultural competent health care are discussed. Following is a review of existing literature with a focus on identifying next steps for future research. Recommendations for licensing, education, and continuing education requirements suggest developing educational research establishing course content and delivery strategies that have measurable impact on improving cultural competency. In addition, existing initiatives need to be evaluated regarding effectiveness in recruiting, retaining, and preparing a diverse workforce. Patient care recommendations focus on further developing an understanding of the factors impacting health outcomes for culturally diverse patients. RESULTS: Further work is needed for translating theoretically-based research into concrete curricula maintaining evidence-based outcomes. It is important to continue with promoting policies ensuring that research and clinical trials include diverse samples and a broad range of variables implicated in differential outcomes. CONCLUSIONS: Based on connections between cultural competency and workforce diversity established within existing literature, data are needed regarding the effectiveness of existing initiatives promoting scholarships, grants, and incentives for improving workforce diversity and funding research on diversity issues. Finally, additional research is needed to evaluate existing and new policies for funding services and access for health services.

Clinical Competence↗
PubMed2005

The pediatric subspecialty workforce: public policy and forces for change.

Policy has not adequately addressed the unique circumstances of pediatric subspecialties, many of which are facing workforce shortages. Pediatric subspecialties, which we define to include all medical and surgical subspecialties, are discrete disciplines that differ significantly from each other and from adult medicine subspecialties. Concerns about a current shortage of pediatric subspecialists overall are driven by indicators ranging from recruitment difficulties to long wait times for appointments. The future supply of pediatric subspecialists and patient access to pediatric subspecialty care will be affected by a number of key factors or forces for change. We discuss 5 of these factors: changing physician and patient demographics; debt load and lifestyle considerations; competition among providers of subspecialty care; equitable reimbursement for subspecialty services; and policy to regulate physician supply. We also identify issues and strategies that medical and specialty societies, pediatric subspecialists, researchers, child advocates, policy makers, and others should consider in the development of subspecialty-specific workforce-policy agendas.

Career Choice↗
PubMedDate not supplied

Trends in international nurse migration.

Predicted shortages and recruitment targets for nurses in developed countries threaten to deplete nurse supply and undermine global health initiatives in developing countries. A twofold approach is required, involving greater diligence by developing countries in creating a largely sustainable domestic nurse workforce and their greater investment through international aid in building nursing education capacity in the less developed countries that supply them with nurses.

Emigration and Immigration↗
PubMed2003

Physicians resources in Lithuania: change comes slowly.

AIM: To analyze the structure of the physician workforce in Lithuania at the time when the country gained independence, changes it has undergone since 1990, and physician resource planning activities. METHODS: National and international databases were examined to determine the changes in the structure of physician workforce after 1990. Studies and reports, funded by international and national governmental organizations, were reviewed to examine the recommendations for physician resource planning and the rate of their acceptance. Since there was no government plan, a study using Delphi technique was conducted to find consensus among practitioners and policy makers on the physician-to-population ratio needed in Lithuania. Medical residents and physicians in Lithuania were surveyed to assess their emigration intentions. RESULTS: In comparison with other Baltic countries, the number of physicians in Lithuania has remained high despite dramatic reductions in the number of students enrolled to medical schools. There is still a maldistribution of physician resources geographically and by specialty. The government has accepted few recommendations based on the international studies. None of the internal databases provided all the needed information on the physician workforce and the existing databases could not be linked to gain access to all required information. CONCLUSIONS: The physician-to-population ratio remained high after Lithuania had gained independence. There has been little planning at the government level to determine the number of physicians needed in a reformed health system. Changes in the number of students admitted to medical schools did not follow from a well thought-out long-term plan for physician workforce the country will need in the future. To develop a frequently updated database of physicians is essential for the successful planning of future physician workforce.

Databases as Topic↗
PubMedDate not supplied

Managing knowledge workers in clinical systems.

In Future Work, Coates and colleagues cite seven forces that are reshaping work and the workforce. One is the advent of "knowledge workers," who gather, distribute, and add value to information. In health care, the transition to integrated delivery systems, replete with care plans, critical paths, and assessment of clinical outcomes supported by information technology, is driving the need to reeducate for a knowledge-based workforce. Managers of clinical systems need to be familiar with the characteristics of knowledge workers affecting the delivery environment, organizational structure, and culture of an organization. These same managers will be expected to develop strategies to manage the transition to a knowledge-based workforce.

Clinical Laboratory Information Systems↗
PubMedDate not supplied

Projecting future medical care costs using four scenarios of lifestyle risk rates.

PURPOSE: This study predicts medical care expenditures over 10 years for Union Pacific Railroad (UPRR) under alternative health risk factor scenarios for the UPRR workforce. DESIGN: This paper describes the development of an economic forecasting model to predict medical care expenditures assuming four different scenarios of population risk. The variables used to predict medical care expenditures are employee demographics and health risk profiles. SETTING: UPRR is a transportation company with more than 56,000 employees in 25 states west and south of the Mississippi River. SUBJECTS: Employees of UPRR. MEASURES: Intermediate outcomes included health risk measures related to exercise patterns, body weight, eating habits, smoking, alcohol consumption, total cholesterol, blood glucose, blood pressure, stress, and depression. Major outcome measures included projected total annual payments by UPRR for medical care services for the decade following 1998. RESULTS: The UPRR work force is projected to grow by 500 employees per year over the 10-year study period. The average age is expected to increase from 44 to 48 years. Without further health promotion intervention, 7 of the 11 risk factors assessed would likely worsen among UPRR's workforce. Medical care cost increases are projected to range from $22.2 million to $99.6 million in constant 1998 dollars over the next decade, depending on the effectiveness of risk factor modification programs. With an expected health promotion budget averaging $1.9 million annually over 10 years, health risks must decline at least 0.09% per year for the program to pay for itself. CONCLUSIONS: Estimating various risk and cost scenarios can facilitate program planning and produce an economic justification for worksite health programs.

Adult↗
PubMed2004

Rethinking midwifery refresher programs as a recruitment strategy.

This paper presents a case study on an innovative Midwifery Refresher Program in the context of current midwifery workforce issues. The refresher program was developed specifically as a recruitment strategy to address a staffing crisis at the Mater Misericordiae Mothers' Hospital, a busy tertiary maternity hospital in Brisbane, Australia. Features of the program that contributed to its success include collaboration with an industry partner, high levels of clinical support for participants, flexibility for women with family responsibilities and low financial costs for all stakeholders. This type of recruitment strategy may be useful for health care services experiencing staff shortages.

Catholicism↗
PubMed2002

Targetting out of the workforce nurses: a promising local recruitment strategy.

A successful pilot program to attract and orient 'out of the workforce' nurses to a hospital outreach acute and post acute care service is described. Three new staff members attended a one-month education program prior to commencing supervised clinical activity. Survey and focus group methods were used to evaluate the initiative. Principal lessons learned were that preceptoring and preceptor support is central to a positive outcome for new and existing staff. We also learned that a tendency to underestimate the complexity of the post acute care nursing role in the initial advertising was unhelpful.

Australia↗
PubMed2003

Learning from lives: a model for health and social care education in the wider community context.

OBJECTIVES: To develop and evaluate a model for medical education which draws upon the whole frontline workforce in primary care and which enables medical students to develop skills and competencies in patient-centred teamworking across organisational boundaries. METHODS: Over a period of 3 years, 517 undergraduate medical students undertook a 4-week community hospital-based attachment developed in partnership with frontline staff. Pre- and post-course questionnaires and qualitative evaluation were sought from students, patients, tutors and frontline staff. RESULTS: The performance of students in assessment was very good. Before receiving the assessment results, students perceived a high degree of achievement of the specified learning outcomes and reported significant changes in attitude. Qualitative comments were overwhelmingly positive, with clear indications that students appreciated the unique learning opportunities available in this model. Patients were very positive about continuing involvement and valued the opportunity to influence future doctors. Staff were enthusiastic and committed despite competing service pressures. CONCLUSIONS: We have successfully developed a partnership model of community-based education and shown that it leads to significant changes in attitude in students and enables them to learn in an active, patient-focused way about the complexities of delivery of care outside the secondary care environment. We have identified the key requirements for implementation of the model in other centres.

Clinical Competence↗
PubMed2005

Recruitment and retention of minority students: diversity in nursing education.

A culturally diverse nursing workforce is essential to meet the health needs of an increasingly diverse Canadian population. The recruitment and retention of nursing students representing diverse backgrounds are vital to the building of this diversified work force. Studies have shown that diversity within the student body benefits everyone. For example, students who study and work within a diverse environment are better able to understand and consider multiple perspectives and to appreciate the benefits inherent in diversity. This paper describes one school of nursing's project on the Recruitment and Retention of Black students into their Bachelor of Science Nursing (BScN) Program. The project goals are to increase diversity, foster student learning, and ultimately improve health care for the Black community. Presented in this paper are the project background, implementation process, challenges and outcomes. This may provide learned lessons and future directions for similar initiatives in other institutions.

Black or African American↗