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PubMed2006

Does decentralisation improve human resource management in the health sector? A case study from China.

A major obstacle to the provision of health services is lack of an effective workforce. Human resource management (HRM) can improve the effectiveness of the workforce, though this is difficult in large bureaucratic organisations. Decentralisation is a common reform strategy and this paper sets out to examine whether HRM would be improved in decentralised settings. Indicators were developed for three areas of HR outcome: (i) appropriate staff numbers, with (ii) appropriate skills and experience, providing, (iii) appropriate inputs to organisational performance. An attempt was made to link these human resource (HR) outcomes to relevant HRM actions in two counties--one richer and one poorer--in Fujian Province, China. One general county hospital and 5 township health centres were selected for study in each country. A health facility-based survey collected information on characteristics of the workforce and staff surveys identified changes in the management of human resources and staff inputs to performance before and after decentralisation. Whilst some benefits were identified from decentralising HRM, the complexity of the decentralisation itself, and other external pressures coupled with inadequate capacity building meant that some HRM actions were not always aligned with health service objectives. Better planning and preparation coupled with strong monitoring would increase the chances of decentralisation improving HRM in the health sector.

China↗

PubMed1998

Profile of public health nutrition personnel: challenges for population/system-focused roles and state-level monitoring.

OBJECTIVE: Our 3 objectives were to document the current public health nutrition workforce in the United States, identify top public health nutrition priorities for the next 5 years, and assess the capacity of public health nutrition personnel to address these priorities and the nutrition-related objectives of Healthy People 2000. DESIGN: A census survey was distributed to public health nutrition personnel in all state and local health agencies and nonprofit and for-profit agencies funded by official health agencies throughout the United States and US territories. Also, state and territorial nutrition directors were sent a different questionnaire. SUBJECTS: Data were collected from 49 states, the District of Columbia, and 2 territories; 7,550 public health nutrition personnel were represented. STATISTICAL ANALYSIS: Data were analyzed using EpiInfo software. Descriptive statistics are presented. RESULTS: Almost half of the respondents worked in local or county health agencies and about two thirds were involved in direct care services. Only about 40% were registered dietitians and about one fourth had a master's degree. Almost 90% of all full-time equivalent positions were funded through federal dollars; 78% of all funding was from the Special Supplemental Nutrition Program for Women, Infants, and Children. Top health concerns identified were diet/nutrition to prevent chronic disease, low breast-feeding rates, low birth weight, iron deficiency anemia, and obesity/overweight. Public health nutrition personnel will be challenged to assume population/system-focused roles and state-level monitoring of Healthy People 2000 objectives. Only 2 of the 17 nutrition objectives of Healthy People 2000 were monitored by more than 50% of the states. APPLICATIONS: If official health agencies are to shift to public health core functions, as recommended by an Institute of Medicine report, then a substantial proportion of the public health nutrition workforce must not only change how they practice but also obtain the knowledge and skills to do so. Strategies to improve workforce capacity are discussed, including continuing education interventions through professional organizations, distance and on-campus educational opportunities through approved public health nutrition programs, and advocacy for new funding streams focused on public health core functions.

Dietetics↗

PubMed2001

Marketplace reforms and primary care career decisions.

A dramatic shift in the postgraduate career choices of medical school graduates toward primary care occurred during the mid-1990s. While some attributed this shift to changes in medical school curricula, perceptions stemming from marketplace reforms were probably responsible. For the most part, these perceptions were probably generated through informal communications among medical students and through the media. More recently, additional marketplace influences, such as the consumer backlash toward managed care and unrealized gains in primary care physicians' personal incomes, may have fostered contrasting perceptions among medical students, leading to career choices away from primary care, particularly family practice. The authors offer two recommendations for enhancing the knowledge of medical students concerning workforce supply and career opportunities: an educational seminar in the second or third year of medical school, and a public-private partnership between the Bureau of Health Professions and the Association of American Medical Colleges to create a national database about the shape of the primary care and specialty workforces, accessible through the Internet for educators, students, and policymakers. The authors conclude that appropriate career counseling through these efficient methods could avoid future abrupt swings in specialty choices of medical school graduates and may facilitate a more predictable physician workforce supply.

Capitation Fee↗

PubMedDate not supplied

Demographic survey of Filipino American nurses.

BACKGROUND AND OBJECTIVE: Recruitment of nurses trained in the Philippines is one strategy employed by US hospitals to increase our nursing workforce. As well, some Filipino American nurses obtained their nursing education in US schools. The objective of our study was to describe demographics, years of practice, work status, educational background, job satisfaction, and years to retirement of a sample of Filipino American nurses. METHODS: A nonexperimental descriptive study was conducted utilizing a convenience sample of 327 Filipino American nurses. RESULTS: Filipino American nurses were primarily educated in the Philippines, held BSNs, worked full time, had high job satisfaction, and planned to retire, on average, in 12 years. CONCLUSIONS: The retirement plans of Filipino American nurses recruited to US hospitals during past workforce shortages forecast vacancies of nurses who have consistently worked full time and report high job satisfaction. Current workforce stakeholders should be alerted to these nurses' plans.

Adult↗

PubMedDate not supplied

The Management Academy for Public Health: the South Carolina experience.

In the late 1990s, the South Carolina Department of Health and Environmental Control (SCDHEC) was faced with the challenges of a workforce that was not prepared in public health; the impending loss of significant agency expertise, leadership, and institutional knowledge through retirement; the lack of available and accessible training; and continuing state budget cuts. Preparedness for bioterrorism and other public health emergencies was also of concern, a need made more urgent after 2001. To respond to current and emerging public health challenges, the SCDHEC had to have a workforce with the knowledge and skills necessary for the delivery of essential public health services. To address these challenges, the department partnered with the University of North Carolina in the pilot of the Management Academy for Public Health. The Management Academy is now integrated into the South Carolina workforce development strategy, and 199 staff members and 22 community partners have graduated from the program. Along with increased knowledge, skills, and abilities of individual staff and increased organizational and community capacity, a significant result of South Carolina's experience with the Management Academy for Public Health is the development of a training program for emergency preparedness modeled on the Management Academy. This highly successful program illustrates the replicability of the Management Academy model.

Humans↗

PubMedDate not supplied

Valuable human capital: the aging health care worker.

With the workforce growing older and the supply of younger workers diminishing, it is critical for health care managers to understand the factors necessary to capitalize on their vintage employees. Retaining this segment of the workforce has a multitude of benefits including the preservation of valuable intellectual capital, which is necessary to ensure that health care organizations maintain their competitive advantage in the consumer-driven market. Retaining the aging employee is possible if health care managers learn the motivators and training differences associated with this category of the workforce. These employees should be considered a valuable resource of human capital because without their extensive expertise, intense loyalty and work ethic, and superior customer service skills, health care organizations could suffer severe economic repercussions in the near future.

Adult↗

PubMed2006

Going country: rural student placement factors associated with future rural employment in nursing and allied health.

OBJECTIVE: To measure the rate and predictors of health science graduates joining the rural health workforce following a rural placement. DESIGN: Longitudinal survey including the years immediately prior to and post graduation. SETTING: Western Australian health sciences graduates contacted by email and/or phone. PARTICIPANTS: Allied health and nursing students from urban campuses of three Western Australian universities who had taken a rural placement in their final year of study between 2000 and 2003. MAIN OUTCOME MEASURES: Location of employment six months or more after graduation. RESULTS: Of 429 participating allied health and nursing graduates, 25% had entered the rural workforce. Factors with a positive bivariate association with rural employment were: rural background, health discipline, self-reported value of placement, non-compulsory rural placement, and placements of four weeks or less. After controlling for rural background, the value and duration of the placement were significantly associated with rural employment. CONCLUSIONS: This study augments previous work showing that any prior rural background is a significant predictor of rural work. Rural practitioners of both urban and rural origin who undertake voluntary rural placements are more likely to enter rural practice and consequently mandatory placements may not be helpful to increasing the rural workforce. The quality of a placement is a highly significant factor associated with future workplace choice, the details of which need to be further investigated.

Allied Health Personnel↗

PubMed2006

Nursing in the United Arab Emirates: an historical background.

AIM: To gain a better understanding of some of the factors that may be contributing to the shortage of national nurses in the United Arab Emirates (UAE). BACKGROUND: Approximately 3% of the UAE nursing workforce are currently nationals, which explains the UAE dependency on transient expatriate nurses. Even though Emirati women have been recently empowered to join the national workforce, not many have joined the nursing profession. Several factors may be contributing, in varying degrees, to this predicament. METHOD: The socio-economic factors as well as the cultural and religious customs that have shaped the country and its people are examined. Hence, the historical background to the establishment of the UAE, women in Islam, the first nurse in Islam, the development of nursing in the UAE and the Emirates Nursing Association are considered. CONCLUSION: Factors contributing to the limited number of UAE nationals in the nursing profession include, but are not limited to: the low status of nursing in the UAE; the variations in basic nursing programmes in the country; the lack of Arabic educational resources; the affluent life style of UAE nationals as well as the strict cultural norms and religious values by which they live. As the need to nationalize the nursing workforce in the UAE is paramount, these issues and other perceived barriers from the perspective of Emirati nurses need to be explored and addressed.

Career Choice↗

PubMed1994

A profile of ICD-9-CM coding staff in NSW and ACT hospitals.

The ICD-9-CM coder workforce is on the brink of major changes given impetus by increasing commitments to casemix-based funding and management strategies within the public and private hospital sectors. A study of the ICD-9-CM coding process in NSW and ACT hospitals was undertaken by the School of Health Information Management, Faculty of Health Sciences, The University of Sydney during 1991. This article profiles the composition of the ICD-9-CM coder workforce in NSW and the ACT based on the findings of this study. Recent developments pertaining to national coder workforce issues are also discussed.

Abstracting and Indexing↗

PubMedDate not supplied

COGME's 16th Report to Congress: too many physicians could be worse than wasted.

Departing from past reports, the latest Council on Graduate Medical Education (COGME) report warns of a physician deficit of 85,000 by 2020 and recommends increases in medical school and residency output. COGME notes that contributions of other clinicians and changes in how medical care is delivered in the future would likely offset physician deficits but chose not to modify their recommendations. COGME offers a relatively minor workforce correction in an otherwise flawed system of health care; however, the nation awaits a reassessment of its physician workforce based on what the nation wants and needs from physicians working in modern systems of care. Great caution should be exercised in expanding the physician workforce. Producing a physician surplus could be far worse than wasted, because the investment required and resulting rise in health care cost may harm, not help, the health of people in the United States. Instead, these resources could be applied in ways that improve health.

Health Workforce↗

PubMedDate not supplied

Nursing shortage redux: turning the corner on an enduring problem.

Projections of a substantial nursing workforce imbalance in the coming decade have galvanized policymakers, providers, private foundations, nurses, and others to proffer aggressive and sustainable strategies to ameliorate the looming shortage. The solutions are largely ones that seek to increase supply. Analysis of the 1992-2000 National Sample Surveys of Registered Nurses shows that increasing losses from the active workforce, stagnant wages, and low levels of job satisfaction pose major impediments to bolstering supply. Strategies focused on working conditions and retention should occupy a central position in any nursing workforce revitalization plan.

Adult↗

PubMedDate not supplied

The occupational transformation of the mental health system.

The mental health workforce has changed dramatically since the mid-1970s. Nonphysician providers, particularly psychologists and clinical social workers, have become a much larger share of the workforce. While the supply of psychiatrists has been relatively stable, there has been a dramatic increase in the supply of psychologists and social workers. Changes in clinical practice, combined with the continued expansion of managed care into mental health, will largely determine the future composition and supply of the mental health workforce.

Forecasting↗

PubMed1998

United States neonatology practice survey: personnel, practice, hospital, and neonatal intensive care unit characteristics.

BACKGROUND: The efficiency and access to existing perinatal resources has become a focus of debate. Despite inconsistent references to the number of neonatologists and unsubstantiated personnel requirement recommendations, recent commentaries have suggested a current 30% to 50% excess in workforce. OBJECTIVE: To describe the current neonatology workforce and its practice patterns. DESIGN: Using a questionnaire developed by the Committee on Practice of the Section on Perinatal Pediatrics of the American Academy of Pediatrics and distributed to 675 neonatology practices identified in the United States Neonatologists Directory 1996, a survey was conducted from July 1, 1995 to June 30, 1996 requesting specific information relating to personnel, type and size of practice, and clinical services provided at practice hospitals. RESULTS: Respondents included 420 neonatology practices (62.2% response rate) representing 2006 neonatologists providing clinical care in 695 hospitals, 652 with delivery services that accounted for 1 646 881 live births in 1994. More than 95% of practices and neonatologists identified themselves as based in university, private, or hospital settings. Eighty percent of neonatologists were <50 years old. There was an overall 2:1 male to female gender distribution. Sixty percent of practices consisted of 4 or fewer neonatologists, 25% of practices 5 to 7 neonatologists, and 15% of practices 8 or more neonatologists. Sixty percent of practices provided clinical care in only 1 hospital and 1 neonatal intensive care unit (NICU) as compared with 15% of practices in 3 or more hospitals and <5% of practices in 3 or more NICUs. Of the total 478 NICUs (22 in children's hospitals), 67% had <501 annual admissions and 33% had more then 500 admissions. Of the 456 NICUs in 652 practice hospitals with delivery services, 61% of hospitals had <2501 annual deliveries (57% with NICUs) and 39% of hospitals had more than 2500 annual deliveries (90% with NICUs). The average inborn admission rate for these practice hospitals was 11.7%. University, private, and hospital practices had consistent rates of admissions for inborn and outborn NICU and special care nursery admissions. More than 60% of neonatology practices were involved in normal newborn care on a routine basis, in addition to staffing developmental clinics and providing inpatient and outpatient pediatric care. Additional information was analyzed for utilization of residents and neonatal nurse practitioners. By 1999, 50% of practices anticipated hiring 279 neonatologists and 575 neonatal nurse practitioners. CONCLUSION: Significant discrepancies between earlier projected neonatologist requirements and current neonatology workforce and service responsibilities are discussed in relation to demands of reallocation of subspecialty resources within an evolving health care system.

Adult↗

PubMed1995

PAs/NPs: forging effective partnerships in managed care systems.

Three issues have dominated national health policy discussions over the past three decades--how to control health expenditures, how to improve access to care, and how to ensure delivery of high-quality health services. Cost remains the principal societal concern today. An important new dimension in this debate, however, is a critical examination of the impact of the structure of the nation's health workforce on health expenditures. Within this examination, policy makers are giving specific attention to the supply of health professionals, the role of primary care, and the identification of the most appropriate professionals to deliver primary care. In particular, a renewed interest is being shown in the potential of physician assistants (PAs) and nurse practitioners (NPs) to address all three issues. This article will examine the factors that prompted this focus on health workforce issues and the implications of the use of PAs and NPs for the structure and management of the health workforce in the future.

Cost Control↗

PubMedDate not supplied

Women and men.

If equal employment opportunities were a reality, one would expect all salaries to be more or less randomly distributed between the genders. The data does not show random distribution. Of the awards studied in depth, 11 of the 18 showed a statistically significant different salary between women and men. Two awards had a marginal probability of significance, and five had a probability of significance of less than five per cent. The data shows clearly the need for EEO initiatives for women within the health service and identifies the areas of greatest concern. The many questions raised through this general analysis of the data will guide further research and the development of an EEO management plan that is specific to the needs of the Palmerston North Area Health Board. Also highlighted is the need for similar statistics showing the composition of the workforce by ethnicity and disability. Only when this has been obtained and analysed can specifically targeted EEO programmes be developed to meet the workforce needs of the Board. Other Boards interested in receiving a statistical analysis of their workforce by gender should contact Patrick Mulcahy at the National Health Statistics Centre, Private Bag 2, Upper Willis Street, Wellington, phone (04) 844-167.

Data Collection↗

PubMed1999

Growth and geographic distribution of selected health professions, 1971-1996.

This article examines the growth and geographic distribution of selected health professions in a 26-year period. The health professionals investigated were physicians, dentists, pharmacists, registered nurses, other health practitioners, dieticians and therapists, medical technologists and technicians, and health service workers. Allied health professions are represented by the last three of these groups. Samples of health professionals were extracted from the Current Population Survey from 1971 to 1996. The ratio technique and GIN1 index are used to describe the growth trend and geographic distribution of each health professional group over time. This historical overview reveals the following general trends in the 1990s: 1) growth of every selected health professional group has slowed down; 2) workforce disparities between the most and least abundantly supplied geographic areas have decreased; 3) selected health professions have become less evenly distributed among the population; and 4) the trends in pharmacy and dentistry call for immediate attention in workforce planning. The findings suggest that with the exception of dentistry, health personnel shortages are no longer an issue in such planning. Future health workforce policies should continue focusing on improving the distribution of workers among the general population.

Allied Health Personnel↗

PubMed2000

Supply, distribution, and capacity of optometrists in Indiana.

BACKGROUND: The Indiana Optometric Association and the Indiana Health Care Professional Development Commission identified a need to collect and analyze data on the health professions workforce for formulating goals and strategies to accommodate demands for health care services in Indiana. This study looks at the supply, distribution, and services of optometrists practicing in Indiana. METHODS: Data compiled by the Indiana State Department of Health, Indiana Health Care Development Commission, and the Project HOPE Center for Health Affairs were analyzed with the results of a survey of practitioner members of the Indiana Optometric Association. Supply, distribution, services, provider-to-population ratios, per capita demand, and optometric productivity were used to evaluate the current and future capacity of Indiana optometrists to the year 2010. RESULTS: An estimated 893 optometrists practiced in 86 of 92 counties and comprised 77% of the state's licensed eye and vision care workforce in 1995. Optometric workforce capacity appeared to be related to county population, but unrelated to the urban/rural classification or the per-capita income of Indiana counties. Contact lenses, disease, geriatrics, and pediatrics were the most prevalent areas of practice specialty. CONCLUSIONS: Optometrist capacity in Indiana is sufficient at both the state and county levels, and optometric services are appropriately distributed such that patient access to optometric care is geographically unburdened. Estimates regarding supply are elastic, depending on the assumptions applied.

Health Personnel↗

PubMedDate not supplied

Why are shortages of hospital RNs concentrated in specialty care units?

This article is the first in a series examining the interplay between the aging of the nurse workforce and other factors driving the growing nursing shortage that are already affecting some specialty areas. Nearly 60% of the current RN workforce is over 40 years of age; and the percentage of RNs under age 30 has fallen by nearly 40% since 1980. The total number of FTE RNs is projected to shrink after 2010, likely resulting in shortages of RNs "when the large baby-boom generation of RNs starts to retire." Because ICUs have historically attracted younger RNs, the rapid decline in the number of RNs in the workforce under age 30 plays a large role in explaining the development of shortages in the ICU. The growing difficulties staffing operating rooms and other peri-operative services is seen as related to the aging work force as more diploma prepared nurses have been attracted to this specialty because they had educational exposure to this area.

Adult↗