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PubMed2004

Cultural attitudes, knowledge, and skills of a health workforce.

This study describes cultural attitudes, knowledge, and skill of 409 health care workers using the Ethnic Attitude Scale, the Cultural Self-Efficacy Scale, and a demographic inventory. Findings suggest cultural knowledge and educational preparation of the health worker may influence cultural skills. Workers that were most confident in their cultural skills in working with other cultural groups were more confident in knowledge of cultural concepts and had higher education levels. The results also suggest gaps in workers' knowledge of other cultures and how to care for them in culturally sensitive ways. Educational interventions may enhance workers' knowledge. Whether such enhanced knowledge yields improved patient care outcomes remains to be answered.

Adult↗
PubMed2005

"Thinking Like a Marketer": training for a shift in the mindset of the public health workforce.

The marketing mindset focuses a practitioner on systematically thinking through key issues before undertaking a health promotion campaign. The Thinking Like a Marketer training, developed by the National Training Collaborative for Social Marketing is a challenging method for health educators and promoters to apply their skills in innovative ways. Focus groups were conducted with former trainees to assess the impact of the training. Additional data were collected from members of the Association of State and Territorial Promotion Directors of Health Promotion and Public Health Education organization through a 10-item elicitation survey. Findings suggest that although participants gained greater sensitivity and appreciation for the social marketing research process, the major barrier to application in the workplace surrounded upper management. On-site technical assistance, mentoring, and follow-up were important training needs identified through the survey and focus groups.

Education, Public Health Professional↗
PubMed2005

Wastage in the health workforce: some perspectives from African countries.

BACKGROUND: Sub-Saharan Africa faces a human resources crisis in the health sector. Over the past two decades its population has increased substantially, with a significant rise in the disease burden due to HIV/AIDS and recurrent communicable diseases and an increased incidence of noncommunicable diseases. This increased demand for health services is met with a rather low supply of health workers, but this notwithstanding, sub-Saharan African countries also experience significant wastage of their human resources stock. METHODS: This paper is a desk review to illustrate suggestions that the way human resources for health (HRH) are trained and deployed in Africa does not enhance productivity and that countries are unable to realize the full potential expected from the working life of their health workers. The paper suggests data types for use in measuring various forms of "wastage". RESULTS: "Direct" wastage--or avoidable increases in loss of staff through factors such as emigration and death--is on the rise, perhaps as a result of the HIV/AIDS epidemic. "Indirect" wastage--which is the result of losses in output and productivity from health professionals' misapplied skills, absenteeism, poor support and lack of supervision--is also common. HIV/AIDS represents a special cause of wastage in Africa. Deaths of health workers, fear of infection, burnout, absenteeism, heavy workloads and stress affect productivity. CONCLUSION: The paper reviews strategies that have been proposed and/or implemented. It suggests areas needing further attention, including: developing and using indicators for monitoring and managing wastage; enhancing motivation and morale of health workers; protecting and valuing the health worker with enhanced occupational safety and welfare systems; and establishing the moral leadership to effectively tackle HIV/AIDS and the brain drain.

Journal Article↗
PubMed2006

Not enough there, too many here: understanding geographical imbalances in the distribution of the health workforce.

Access to good-quality health services is crucial for the improvement of many health outcomes, such as those targeted by the Millennium Development Goals (MDGs) adopted by the international community in 2000. The health-related MDGs cannot be achieved if vulnerable populations do not have access to skilled personnel and to other necessary inputs. This paper focuses on the geographical dimension of access and on one of its critical determinants: the availability of qualified personnel. The objective of this paper is to offer a better understanding of the determinants of geographical imbalances in the distribution of health personnel, and to identify and assess the strategies developed to correct them. It reviews the recent literature on determinants, barriers and the effects of strategies that attempted to correct geographical imbalances, with a focus on empirical studies from developing and developed countries. An analysis of determinants of success and failures of strategies implemented, and a summary of lessons learnt, is included.

Journal Article↗
PubMed2004

Recruiting and developing an effective workforce in the British NHS.

The British NHS faces major challenges recruiting, motivating and retaining staff in a period of sustained growth and change. This paper examines the prevalence of skill shortages and organisations' coping strategies, as well the factors that motivate staff in the workplace and in the NHS in particular. It argues that the evidence base for informed policy-making needs radical improvement. It then considers a number of approaches to pay that are being used or suggested to attract, motivate and retain staff. These include performance pay, team pay and local pay determination, as well as considering broader factors such as morale and staff development. The paper then draws together some conclusions for policy-makers. These argue that better evidence is needed as to what is happening in the public sector labour market in order to frame appropriate responses and that thorough evaluation of policy initiatives is necessary to establish their utility before their widespread implementation.

Employment↗
PubMed2004

Diversity and consistency: the challenge of maintaining quality in a multidisciplinary workforce.

Non-physician clinicians have become prominent providers of patient services within the practice of medicine. They include nurse practitioners and clinical nurse specialists, physician assistants, the alternative and complementary disciplines (chiropractic, naturopathy and acupuncture), mental health providers (psychologists, clinical social workers, counsellors and therapists) and specialty disciplines (optometrists, podiatrists, nurse anaesthetists and nurse-midwives). Although these various disciplines have differing histories and philosophic frameworks, which create distinctive approaches to patient care, they have shared a struggle to obtain recognition and autonomy through state licensure, to expand their state-granted practice prerogatives and to achieve broader reimbursement from third-party payers and managed care. Most entered into a growth spurt beginning in the early 1990s. All now provide care that not only overlaps that of physicians but that complements and supplements that care. The central question is, how does their care contribute to quality? The evidence thus far shows that non-physician clinicians throughout the range of disciplines can produce high-quality outcomes under particular circumstances. However, the strongest body of evidence is derived from care that is at the least complex end of the clinical spectrum or that is provided under the umbrella of physicians. Unfortunately, few studies have critically examined the outcomes of non-physician clinicians at the leading edge of their practice prerogatives and under conditions that are free of physician oversight. Thus, while the principle that they can deliver high quality care within the practice of medicine is unequivocally true, more research is needed to test this principle under conditions of greater clinical complexity and autonomy, and, pending the results of such research, caution must be exercised in applying this principle too broadly.

Humans↗
PubMed2004

Regulating the health care workforce: next steps for research.

This article explores the recent ferment surrounding professional self-regulation in medicine and other health professions. It reviews the academic literature and sets out an agenda for research. The first section considers definitions, acknowledging the particularly complex regulatory maze in UK health care at present, in which professional self-regulation is only one part. The second section reviews academic writing, currently dispersed among the disciplines. 'The logic of light touch regulation', a feature of the 19th century establishment of the General Medical Council, can perhaps shed light on present debates. Alongside the intense political spotlight on regulation in the wake of the Bristol case, consumer-led research and consumer pressure to rethink the principles of regulation has emerged. This is examined in the third section. Finally, themes for research are advanced. First, there is a need to explore the changing relationship between the state and professions and implications, not only for the professions but for health care more broadly. Second, calls for a new professionalism need to be given clearer content. Third, the moves towards more lay involvement in regulatory bodies need study. Fourth, questions of human rights and professional registers must be explored. Fundamental questions of what professional self-regulation can hope to achieve and where it fits in relation to government ambitions as a whole, remain unresolved. Alongside the work programme of the new overarching regulator, there may well be scope for a new style of public enquiry covering the whole territory of regulation.

Health Personnel↗
PubMed1990

Environmental and workplace contamination in the semiconductor industry: implications for future health of the workforce and community.

The semiconductor industry has been an enormous worldwide growth industry. At the heart of computer and other electronic technological advances, the environment in and around these manufacturing facilities has not been scrutinized to fully detail the health effects to the workers and the community from such exposures. Hazard identification in this industry leads to the conclusion that there are many sources of potential exposure to chemicals including arsenic, solvents, photoactive polymers and other materials. As the size of the semiconductor work force expands, the potential for adverse health effects, ranging from transient irritant symptoms to reproductive effects and cancer, must be determined and control measures instituted. Risk assessments need to be effected for areas where these facilities conduct manufacturing. The predominance of women in the manufacturing areas requires evaluating the exposures to reproductive hazards and outcomes. Arsenic exposures must also be evaluated and minimized, especially for maintenance workers; evaluation for lung and skin cancers is also appropriate.

Arsenic↗