Healthcare workforce planning

The WHO defines HRH (Human resource for health) planning as “the process of estimating the number of individuals and the types of knowledge, skills and attitudes they need to achieve predetermined health goals and ultimately health goals”.

HR planning is a dynamic process, consists of 3 phases; inventory, forecasting and designing temporary staff. In the first phase of the inventory, the recruitment and selection of key types of employees align with the strategic business plan to achieve specific goals. The second stage of forecasting is divided into two stages, forecasting people’s future needs (demand forecasting) and forecasting people’s availability (stock forecasting). The third and final phase involves a flexible strategy to recruit temporary workers based on needs assessment and cost-effective benefits.

1. Inventory: – The principle is to determine how many people at each level of the organization are needed to achieve the business objectives – in line with the overall strategic plans – and what kind of knowledge, skills, capabilities and other characteristics these people need .

The optimal occupation of modern health services requires many different types of personnel. Among which; –

1. Clinical workers – doctors and nurses.

2. Technical personnel for diagnostic services, such as laboratory & radiology, pharmacy personnel.

3. Environmental health professionals, such as health inspectors.

4. Preventive and incentive staff, such as health workers, administrative staff, etc.

In a healthcare organization, a traditional quantitative approach is used to make enumerative assessments based on managers’ subjective predictions to allocate certain budgets for employee payroll costs and the needs assessment of key employees that respond to the organization’s system and design. Resource allocation is best accomplished using activity-based cost management, which controls costs and labor for a specific task/event and reduces waste.

For example: Comparative rates of care activity:-

Days of hospitalization per capita

Bed days for acute care per capita

Ratio of acute care staff – staff per bed

Ratio of acute care nurses – staff per bed

Inpatient admissions per 1000 inhabitants

Acute care admissions per 1000 inhabitants

Doctor consultations per capita.

The type of health workforce in a particular country is determined by the type of health services and the level of technology available.

For example: –

Nature of the health organization: primary, secondary and tertiary.

Sector types: public, private, non-profit funded organization.

Infrastructure: hospital size (200 beds, 400 beds, 1000 beds).

General (multispecialism) or specific care providers (cardiovascular, cancer).

2. Forecast:-

Demand forecasting: – Planning for the medical workforce is complex and determined by relatively mechanistic estimates of demand for medical care. dr. Thomas L. Hall (1991) suggested 5 generic methods to estimate health care demand, such as:

1. Method for the ratio of personnel to population:- This method calculates the ratio of the number of health

Staff compared to the number of inhabitants. However, with inappropriate data available, it has serious limitations such as it only applies with acceptable health conditions, a stable health sector and limited capacity for planning.

2. The Health Needs Method: -This method requires and translates expert opinion on people’s health needs into the needs of the workforce. Health needs are derived from the determination of disease-specific mortality and morbidity rates. The personnel requirements are evaluated based on the standards for the number, type, frequency and quality of services, and the personnel standards that translate the services into time requirements by a particular category of health professionals to perform the services. This method leads to the need for advanced data systems and research capabilities, and a high level of planning expertise that are not readily available.

3. The Service Demands Method: -This method takes into account the number and types of health services that people will use at the expected cost of obtaining them, rather than their professionally determined need for such services. Specifically, this provides data on economic regression regarding the use of private health care compared to the publicly funded health sector.

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4. Working method of the managed care system: – In the managed care system, there is a known client population that would reasonably have good access to health facilities. But flexible socio-political trends and economic recession are influencing health care reform policies.

Supply forecast: –

When forecasting the HR offer, information from the internal & external labor market is used. The calculation of employee turnover and employee stability indices measures internal HR planning offerings. External labor market provides detailed spectrum on supply shortage, demographic factors and social/geographical aspects.

Internal Offerings:- Evaluating the gross number of people required for a specific job & arranging other facilities of HR processes such as training and development programs, transfer and promotion policies, retirement, career planning and others are critical in maintaining a constant supply of HR in an organization.

1. Stock & flow model: – This model follows the employee’s path through the organization over time, & tries to predict how many employees are needed & in which part of the organization.

a) Waste analysis; – This analysis refers to the rate at which people leave the organization, or reflects the turnover index.

The number of people who leave in a certain period

Waste analysis = x 100

The average number of employees in the same period

b) Stability analysis (Bowey, 1974): – This method is useful in analyzing the amount of waste in terms of service time.

Total service time of the personnel employed at the time of analysis

Stability analysis=x 100

Total possible service time if no manpower was wasted

2. Replacement Schemes: – Replacement Scheme is a list of employees for promotion, selected on the opinions and recommendations of senior people (Mello, 2005). Some replacement charts are more systematic and show an employee’s skills, abilities, competencies and experience levels.

3. Succession Planning: – An aging workforce and emerging “baby boom” retirement waves are driving the need for a new management process known as succession planning, which analyzes and forecasts talent potential to execute on business strategy.

Will Powley, senior consulting manager for GE Healthcare’s performance solutions group, says the first step in effective succession planning is a quarterly talent assessment that begins with an examination of the hospital’s org chart or health system.

In a 2008 white paper on succession planning, GE Healthcare identified a few healthcare best practices for succession planning:

1. Identify and develop talent at all levels

2. Rigorously and repeatedly assess the talent of the top performer

3. Close talent management with external recruiting

4. Keep senior management actively involved

5. Emphasize on-the-job leadership and employee development

6. Make systematic talent assessments and follow-up plans

7. Maintain the dialogue with potential future leaders.

External supply: – HR managers use external information, such as labor market statistics from the organization & external labor market, ie external & internal statistics.

External Statistics: – Graduate Profile

Unemployment Rates

Skill Levels

Age profile

Graduate Profile: – There is substantial public sector regulation of all healthcare markets, and access to the labor market is severely restricted by licensing and professional regulation.

Unemployment rates: – There is a lack of economic principles, the role of incentives is largely ignored and the elasticity of supply in the labor market is largely unknown and poorly researched.

Skill Levels: – Higher education (specialization and super specialization) are proportionally limited to limited admission places administered by medical regulatory authorities.

Age Profile:- Recruitment org charts detail employee recruitment, retention, return and early retirement, helping to enumerate future vacancy rates, shortages and need for replacement.

Internal Statistics: – Demographic Profile

Geographical distribution

Demographic profile: – Demographic changes (eg the number of young people entering the labor market) influence the external labor supply. The age composition of the workforce forces the recruitment policy to be revised. The trend of an increasing share of women in the labor market has led to a gradual development of both the organization and the country.

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Geographical distribution: – The attractiveness of the workforce to urban areas is influenced by the following reasons; employment, access to facilities – transportation and technology, and others.

3. Temporary Staff Scheduling:-

Herer & Harel (1998) classify agency workers as: agency workers, contract workers, consultants, hired workers and outsourcing.

High social costs have initiated a work-sharing strategy that is flexible and offers more benefits, such as:

1. Numbers and hours of part-time agency workers can be easily adjusted with low maintenance costs to meet organizational needs,

2. Employees with appropriate/specialized skills benefit functional areas within and outside the organization.

3. No Responsibility for Exclusive Enrollments for Benefits, such as Job Security, Retirement Plan, Insurance Coverage, etc.

In today’s work environment, outsourcing can be added as a temporary worker scheduling technique. Outsourcing requirement is assessed and evaluated on a cost-benefit basis. Outpatient services, pathology or diagnostic testing services, laundry, catering, billing, medical transcription and others are usually outsourcing services promoted in healthcare organizations.