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PubMed2001

Effects of de-industrialization on unemployment, re-employment, and work conditions in a manufacturing workforce.

BACKGROUND: The purpose of this study was to investigate the impact of a 20-year process of de-industrialization in the British Columbia (BC) sawmill industry on labour force trajectories, unemployment history, and physical and psychosocial work conditions as these are important determinants of health in workforces. METHODS: The study is based on a sample of 1,885 respondents all of whom were sawmill workers in 1979, a year prior to commencement of de-industrialization and who were followed up and interviewed approximately 20 years later. RESULTS: Forty percent of workers, 64 years and under, were employed outside the sawmill sector at time of interview. Approximately one third of workers, aged 64 and under, experienced 25 months of more of unemployment during the study period. Only, 1.5% of workers were identified as a "hard core" group of long-term unemployed. Workers re-employed outside the sawmill sector experienced improved physical and psychosocial work conditions relative to those employed in sawmills during the study period. This benefit was greatest for workers originally in unskilled and semi-skilled jobs in sawmills. CONCLUSIONS: This study shows that future health studies should pay particular attention to long-term employees in manufacturing who may have gone through de-industrialization resulting in exposures to a combination of sustained job insecurity, cyclical unemployment, and adverse physical and psychosocial work conditions.

Adult↗

PubMed2004

Decentralization's impact on the health workforce: Perspectives of managers, workers and national leaders.

Designers and implementers of decentralization and other reform measures have focused much attention on financial and structural reform measures, but ignored their human resource implications. Concern is mounting about the impact that the reallocation of roles and responsibilities has had on the health workforce and its management, but the experiences and lessons of different countries have not been widely shared. This paper examines evidence from published literature on decentralization's impact on the demand side of the human resource equation, as well as the factors that have contributed to the impact. The elements that make such an impact analysis exceptionally complex are identified. They include the mode of decentralization that a country is implementing, the level of responsibility for the salary budget and pay determination, and the civil service status of transferred health workers.The main body of the paper is devoted to examining decentralization's impact on human resource issues from three different perspectives: that of local health managers, health workers themselves, and national health leaders. These three groups have different concerns in the human resource realm, and consequently, have been differently affected by decentralization processes. The paper concludes with recommendations regarding three key concerns that national authorities and international agencies should give prompt attention to. They are (1) defining the essential human resource policy, planning and management skills for national human resource managers who work in decentralized countries, and developing training programs to equip them with such skills; (2) supporting research that focuses on improving the knowledge base of how different modes of decentralization impact on staffing equity; and (3) identifying factors that most critically influence health worker motivation and performance under decentralization, and documenting the most cost-effective best practices to improve them. Notable experiences from South Africa, Ghana, Indonesia and Mexico are shared in an annex.

Journal Article↗

PubMed2005

The health workforce crisis in TB control: a report from high-burden countries.

BACKGROUND: Human resources (HR) constraints have been reported as one of the main barriers to achieving the 2005 global tuberculosis (TB) control targets in 18 of the 22 TB high-burden countries (HBCs); consequently we try to assess the current HR available for TB control in HBCs. METHODS: A standard questionnaire designed to collect information on staff numbers, skills, training activities and current staff shortages at different health service levels was sent to national TB control programme managers in all HBCs. RESULTS: Nineteen HBCs (86%) replied, and 17 (77%) followed the questionnaire format to provide data. Complete information on staff numbers at all service levels was available from nine countries and data on skill levels and training were complete in six countries. Data showed considerable variations in staff numbers, proportions of trained staff, length of courses and quality of training activities. Eleven HBCs had developed training materials, many used implementation guidelines for training and only three used participatory educational methods. Two countries reported shortages of staff at district health facility level, whereas 14 reported shortages at central level. There was no apparent association between reported staff numbers (and skills) and the country's TB burden or current case detection rates (CDR). CONCLUSION: There were few readily available data on HR for TB control in HBCs, particularly in the larger ones. The great variations in staff numbers and the poor association between information on workforce, proportion of trained staff, and length and quality of courses suggested a lack of valid information and/or poor data reliability. There is urgent need to support HBCs to develop a comprehensive HR strategy involving short-term and long-term HR development plans and strengthening their HR planning and management capabilities.

Journal Article↗

PubMed2006

Estimating health workforce needs for antiretroviral therapy in resource-limited settings.

BACKGROUND: Efforts to increase access to life-saving treatment, including antiretroviral therapy (ART), for people living with HIV/AIDS in resource-limited settings has been the growing focus of international efforts. One of the greatest challenges to scaling up will be the limited supply of adequately trained human resources for health, including doctors, nurses, pharmacists and other skilled providers. As national treatment programmes are planned, better estimates of human resource needs and improved approaches to assessing the impact of different staffing models are critically needed. However there have been few systematic assessments of staffing patterns in existing programmes or of the estimates being used in planning larger programmes. METHODS: We reviewed the published literature and selected plans and scaling-up proposals, interviewed experts and collected data on staffing patterns at existing treatment sites through a structured survey and site visits. RESULTS: We found a wide range of staffing patterns and patient-provider ratios in existing and planned treatment programmes. Many factors influenced health workforce needs, including task assignments, delivery models, other staff responsibilities and programme size. Overall, the number of health care workers required to provide ART to 1000 patients included 1-2 physicians, 2-7 nurses, <1 to 3 pharmacy staff, and a much wider range of counsellors and treatment supporters. We estimate from these data that the equivalent of 20,000 to 100,000 physicians, nurses, pharmacists and other core clinical staff will be needed to meet the WHO target of treating 3 million people by the end of 2005. The total number of staff, including counsellors, administrators and other cadres, could be substantially higher. DISCUSSION: These data are consistent with other estimates of human resource requirements for antiretroviral therapy, but highlight the considerable variability of current staffing models and the importance of a broad range of factors in determining personnel needs. Few outcome or cost data are currently available to assess the effectiveness and efficiency of different staffing models, and it will be important to develop improved methods for gathering this information as treatment programmes are scaled up.

Journal Article↗

PubMed2006

Addressing the health workforce crisis: towards a common approach.

The challenges in the health workforce are well known and clearly documented. What is not so clearly understood is how to address these issues in a comprehensive and integrated manner that will lead to solutions. This editorial presents--and invites comments on--a technical framework intended to raise awareness among donors and multisector organizations outside ministries of health and to guide planning and strategy development at the country level.

Editorial↗

PubMed2006

Occupational health for an ageing workforce: do we need a geriatric perspective?

Extending retirement ages and anti-age discrimination policies will increase the numbers of older workers in the future. Occupational health physicians may have to draw upon the principles and experience of geriatric medicine to manage these older workers. Examples of common geriatric syndromes that will have an impact on occupational health are mild cognitive impairment and falls at the workplace. Shifts in paradigms and further research into the occupational health problems of an ageing workforce will be needed.

Journal Article↗

PubMed2004

Educating the future workforce: building the evidence about interprofessional learning.

This paper addresses the theme of interprofessional education for health and social care professionals as it affects the development of the workforce. The drivers for change in the UK, typified by the Bristol Royal Infirmary and Victoria Climbié inquiries and the response to these in the form of Department of Health policy, are discussed. The need for rapid development of the evidence base around this subject is evident from literature reviews of the impact of interprofessional education. Directions for future research and investment in this area are proposed, including the need for a stronger theoretical base and for longitudinal studies over extended periods of time in order to examine short, medium and long-term outcomes in relation to health care practice.

Employment↗

PubMed2004

Changing the skill-mix of the health care workforce.

OBJECTIVE: Changing workforce skill-mix is one strategy for improving the effectiveness and efficiency of health care. Our aim was to summarise available research into the success or failure of skill-mix change in achieving planned outcomes. METHODS: A systematic search for existing reviews of research into skill-mix was conducted. Databases searched included: MEDLINE, CINAHL, PsychINFO, Cochrane Library, HMIC, Centre for Reviews and Dissemination, and Department of Health Research Findings Register. Search terms included keywords defining the type of publication, clinical area, type of health personnel and the focus of the article (role change, skill-mix, etc.). English language publications from 1990 onwards were included. Two reviewers independently identified relevant publications, graded the quality of reviews and extracted findings. In addition, the wider literature was scanned to identify which factors were associated with the success or failure of skill-mix change. RESULTS: A total of 9064 publications were identified, of which 24 met our inclusion criteria. There was a dearth of research, particularly for role changes involving workers other than doctors or nurses. Cost-effectiveness was generally not evaluated, nor was the wider impact of change on health care systems. The wider literature suggested that factors promoting success include: introducing 'treatments' of proven efficacy; appropriate staff education and training; removal of unhelpful boundary demarcations between staff or service sectors; appropriate pay and reward systems; and good strategic planning and human resource management. Unintended consequences sometimes occurred in respect of: staff morale and workload; coordination of care; continuity of care; and cost. CONCLUSIONS: In order to make informed choices, health care planners need good research evidence about the likely consequences of skill-mix change. The findings from existing research need to be made more accessible while the dearth of evidence makes new research necessary.

Clinical Competence↗

PubMed2002

A flexible nursing workforce: realities and fallouts.

While policy-makers are increasingly concerned about a looming nursing shortage, almost half of Canada's nursing workforce is currently employed on a part-time or casual basis. Why are so many nurses not working full-time and providing the nursing care that would help to alleviate such shortages in our healthcare organizations? Do nurses want to work part-time, or are they driven into this by labour market forces, life demands, poor working conditions and policy decisions external to them? The answers to these questions are critical to ensure that care will be there for all of us. This article presents a brief analysis of flexible employment arrangements in nursing, particularly part-time and casual work, and the impact on nurses, patients and the healthcare system as a whole. Given the sharp increases in these work arrangements in Canada during the last decade, the limited discussion of these trends in the literature is both surprising and troublesome.

Canada↗

PubMedDate not supplied

Pharmacists' desired and actual times in work activities: evidence of gaps from the 2004 National Pharmacist Workforce Study.

OBJECTIVES: To describe pharmacists' work activities in the United States during 2004 in terms of (1) the desired amount of time they would like to spend in each of four work activities (medication dispensing, consultation, business management, drug use management), (2) the amount of time they actually spend in each activity, and (3) the gaps between desired and actual time reported in each activity. DESIGN: Cross-sectional study. SETTING: Pharmacies (community chain, community independent, hospital, and other) in the United States. PARTICIPANTS: 1,564 actively practicing pharmacists. INTERVENTION: Mailed survey from portions of the 2004 National Pharmacist Workforce Survey. MAIN OUTCOME MEASURES: Differences between desired and actual time spent in work activities in medication dispensing, consultation, business management, and drug use management and the associations between practice setting characteristics and demographic variables were explored using linear and logistic regression analyses. Practice variables included position, years in current position, working part time, work with other pharmacists, work with technicians, proportion of staff who are pharmacists, staff size, dispensing level. Demographic variables included age, gender, race, marital status, and year of licensure with respondents' reported work activity amounts and gaps. Linear regression results were interpreted based on standardized beta coefficients and corresponding P values. Logistic regression results were interpreted based on 95% confidence intervals for odds ratios. RESULTS: The proportion of time pharmacists devoted to medication dispensing, consultation, business management, and drug use management did not change between 2000 and 2004. Practice setting was the most consistently influential variable on pharmacists' work activities when controlling for other variables. Pharmacists in all practice settings would like to spend more time in consultation and drug use management and less time in medication dispensing, but compared with community pharmacists, hospital and other patient care pharmacists were less likely to report a gap between desired and actual time spent in dispensing activities. Age was a significant predictor of gaps between desired and actual time spent in various activities, but only the oldest age groups (ages of 60 or 70 years and older) were significantly different from the reference group of pharmacists aged 23 to 30 years. CONCLUSION: Pharmacists would like to devote more of their time to consultation and drug use management activities in community pharmacy settings but have not yet been afforded a full opportunity to engage in these activities to the extent that they desire.

Adult↗

PubMedDate not supplied

Prepaid group practice staffing and U.S. physician supply: lessons for workforce policy.

This paper describes staffing at eight large prepaid group practices (PGPs) serving more than eight million enrollees at Kaiser Permanente and two other health maintenance organizations (HMOs). Even after characteristics of the patient populations and outside referrals are accounted for, these PGPs have a physician-to-population ratio that is 22-37 percent below the national rate. Two decades of historical data at Kaiser Permanente indicate that its rate of specialist growth was far higher than that of primary care. The study suggests that efficient systems of care can readily meet the demands of patient populations with workforce staffing ratios below current U.S. levels.

Employment↗

PubMed2005

The changing composition of the pediatric medical subspecialty workforce.

OBJECTIVES: To characterize the composition of the pediatric subspecialty workforce in terms of the distribution of women and international medical graduates (IMGs) across pediatric medical subspecialties and to determine whether the proportions of board-certified pediatric subspecialists who are women or IMGs differ between graduation cohorts. STUDY DESIGN: We used board certification data from the American Board of Pediatrics. Within each pediatric subspecialty, we classified physicians into 2 groups, ie, recent graduates, defined as those who completed medical school after January 1, 1987, and nonrecent graduates, who completed medical school before that date. We calculated the percentage of female physicians for each subspecialty and computed 95% confidence intervals around those estimates to identify male-dominated subspecialties. Using Pearson chi2 tests, we compared the percentages of women between the 2 graduation cohorts for each subspecialty. Similar calculations were performed for the percentage of IMGs in each subspecialty. Sensitivity analyses were performed with data from the 2002 American Medical Association Physician Masterfile. RESULTS: For 9 of 16 pediatric medical subspecialties studied, the percentages of board-certified women were significantly greater in the recent cohort than in the nonrecent cohort. Subspecialties that remain predominantly male in the recent graduation cohort include cardiology, critical care medicine, gastroenterology, pulmonology, and sports medicine. In contrast, the percentages of board-certified IMGs were significantly lower for 6 of the 16 specialties studied; endocrinology and gastroenterology remain relatively reliant on IMGs. CONCLUSIONS: For the majority of pediatric medical subspecialties, concerns that the predominance of women in pediatric training may negatively affect the supply of subspecialists are likely unfounded; however, a small number of procedure-based specialties, as well as sports medicine, continue to rely disproportionately on men. There do not seem to be consistent differences in the role of IMGs across the pediatric medical subspecialties between recent and nonrecent graduates, which may reflect differing tendencies to become certified.

Certification↗

PubMed2005

Workforce issues in rural areas: a focus on policy equity.

Rural communities in the United States are served by relatively fewer health care professionals than urban or suburban areas. I review the geographic distribution of 6 classes of health professionals and describe the multiple government and private policies and programs intended to affect their geographic distribution. These programs can be classified into 3 categories--coercive, normative, and utilitarian--that characterize the major policy levers used to influence practice location decisions. Health workforce policies must be normative to ensure equity for rural communities, but goals in this area can be achieved only through a balance of utilitarian and coercive mechanisms.

Dentists↗

PubMed1979

Hazards in the hospital: educating the workforce through its union.

The hospital workforce is exposed to many occupational hazards of which most hospital workers are unaware. The author and another health educator, both employed with the California State Department of Health, conducted occupational health and safety educational sessions for the membership of a hospital workers' union. These sessions taught nonprofessional workers how to recognize hospital hazards, how to eliminate or minimize these hazards, and informed workers of their legal rights under the California Occupational Safety and Health Act. We first had to convince the union health and safety officer that we had skills and information which would be of benefit to the union. Once that hurdle was crossed, we encountered some difficulty conducting an adequate needs assessment and including the target population in the planning of the educationals. Two series of educational sessions for rank-and-file members were conducted and were enthusiastically received by those attending, with a request for more sessions.

Accidents, Occupational↗

PubMed2003

Faculty for the millennium: changes needed to attract the emerging workforce into nursing.

The twenty-something generation wants educators who nurture, motivate, and listen. Personal attention is important to these students who are entering nursing education programs that are under great pressure to produce more nurses. To compete with other career options and address the global nursing shortage, nursing education must be considered a collaborator, rather than a barrier. Aging faculty and declining faculty numbers increase the challenges related to recruiting and retaining the emerging workforce in nursing professions. This study explored what young students want in their faculty and new options for increasing the number of nursing graduates.

Adult↗

PubMed1999

Nurses re-entering the workforce: a special needs group.

Registered Nurses wishing to re-enter the paid workforce have been shown to experience low self-esteem and high levels of anxiety. An intensive twelve-week re-entry program was designed to address these needs through a process of critical pedagogy. In this paper the student cohort since 1995 is described and the program, its structure, style, physical environment, teaching, and course content are introduced. Evaluation of student outcomes was ascertained by a convenience survey in which a questionnaire was posted to successful students. The results included employment rates of 97.4% and high levels of work and personal satisfaction. Both the benefits and the limitations of the program are discussed in light of the questionnaire responses.

Adult↗

PubMed2005

Occupational risk of affective and stress-related disorders in the Danish workforce.

OBJECTIVES: A population-based, nested, case-control study was carried out to quantify the risk of affective and stress-related disorders according to occupation in the entire Danish workforce. METHODS: All incident hospital patients and out-patients aged 18-65 years who received a first-time-ever diagnosis of an affective disorder (ICD-10, F 30-39) or stress-related condition (ICD-10, F 40-48) in Denmark from 1 January 1995 through 31 December 1998 were identified in the Danish Psychiatric Central Research Register (N=28 971). For each case, five randomly selected referents of the same age and gender were drawn from a 5% sample of the Danish population (N= 144 855). The occupation held 1 year before a person became a case was obtained from Denmark's Integrated Database for Labour Market Research. Occupation was classified according to the Danish version of the International Standard Classification of Occupations (ICD). Relative risks (RR) and 95% confidence intervals (95% CI) for 25 occupational categories with clerical staff as the reference were calculated using a conditional logistic regression adjusted for sociodemographic covariates. RESULTS: Eight occupations were associated with significantly elevated risks (RR range 1.20-1.58) among the women, while eight occupations were associated with a significantly reduced risk (RR range 0.50-0.76) among the men. The risks were highest for the teaching (RR 1.58) and health (RR 1.53) professions. Only social workers and professionals caring for mentally and physically disabled persons faced an elevated risk irrespective of gender (women RR 1.72, 95% CI 1.38-2.16; men RR 2.09, 95% CI 1.38-3-15). CONCLUSIONS: Major depression and stress-related psychiatric disorders are related to occupation. Risk profiles vary strongly according to gender.

Adolescent↗

PubMed1990

Foreign medical graduates. The experience of the Australian Medical Examining Council and the Australian Medical Council, 1978-1989: implications for medical immigration and the medical workforce.

From July 1978 to March 1989, 1703 foreign medical graduates who entered Australia as immigrants took the examinations of the Australian Medical Examining Council (AMEC) and its successor since 1986, the Australian Medical Council (AMC). Of these, 821 (48.2%) passed the multiple choice question examinations and, of these, 627 (76.3%) passed the clinical examinations. The overall pass rate was 36.8%. The majority of those who passed required more than one attempt to do so. Graduates of medical schools from South Africa, Canada and the United States were, in general, more successful than those from other countries by a large margin. Most candidates were graduates of medical schools in third-world countries and Eastern Europe, and although substantial numbers ultimately passed, few of them had reached the same level of competence as graduates from South Africa and North America. There are many probable reasons for their generally poor performance, the most likely being the quality of their medical education in preclinical and clinical sciences and their lack of substantial postgraduate experience. A second factor for some is their inadequate command of English. A third factor is age. Of 547 candidates who presented for the first time in 1988 and 1989, 258 (47%) were 35 or more years old. Since 1984 medical immigration has trebled and is still rising. At the present rate of growth, foreign graduates sitting the AMC examinations for the first time in 1994 will number approximately 482, which (assuming all pass) will be equivalent to 40% of doctors expected to graduate from the 10 Australian medical schools in that year. In spite of a more than adequate supply of locally qualified doctors, Australia, through easy immigration, has become a target country for foreign medical graduates. The high failure rate in the AMC examinations has led to immigrant-activated political pressure for bridging courses and other concessions. If, as a result, the majority of the immigrants were to pass the AMC examinations and so enter general practice, medical immigration will increase at an even faster rate than it has since 1984, with significant changes in the medical workforce. Some reforms which might avert this are suggested.

Adult↗