hill-times-logoWe would have ready access to the best evidence to support health workforce innovations and to support those who must make the hard decisions about health workforce issues. An observatory would help
to shift us away from crisis management towards an approach that is future-oriented.

By: Ivy Lynn Bourgeault, Morris L. Barer
Feb. 06, 2012

Following the mid-January meeting of the premiers regarding the future of Canadian health care, a communiqué was issued announcing the creation of a working group on health-care innovation to examine three critical issues related to the health workforce. These issues include examining the scopes of practice of health-care providers to better meet patient needs, better coordinate management of health human resources and accelerate the adoption of clinical practice guidelines (CPGs).

It is refreshing to see attention paid at this level to broader health workforce issues regarding what health care providers actually do. Typically, the public dialogue around the health workforce is narrowly focused on addressing alleged shortages and other supply related crises, real or imagined.

We are all familiar with the now common political promise of more doctors and more nurses. And at least in the case of the former, we are well along the road to fulfilling that promise, in spades—first year enrolment in Canadian medical schools is now 80 per cent higher than a decade ago.

Indeed, policy-makers are running the risk of over-reaction. Many commentators on the state of health care in Canada have noted that we are not so much suffering from a lack of health-care professionals as from their inappropriate deployment. In other words, we could be doing more, and better, with existing resources. Indeed, times of constraint can be a stimulus to needed change, whereas times of excess can be an impediment to appropriate efficiency improvements.

But before we get too excited about this latest political announcement, a bit of historical context is important. Scopes of practice, coordinated management and CPGs have all come under a variety of committee, task force, working group and royal commission lenses over the past two decades. As important as that work has been, the intermittent nature of these endeavours has resulted in a frustrating lack of follow through or haphazard implementation of a series of well-crafted, often evidence-based recommendations.

Health workforce issues are health care policy's great soap opera.

Skip a decade and then pick up the thread, and you'll feel right at home in the midst of the same recurring issues. Indeed, we have known from research now almost 40 years old, and based in Canada, about the huge potential for nurse practitioners in primary care. Yet implementation of this single scope-of-practice-related finding continues to be hamstrung by a maddening mix of professional resistance and lack of political will.

Instead, we train ever more physicians.

This history of failed implementation of thoughtful recommendations is readily apparent to the various health workforce stakeholders who have been around for any length of time.

There is now a chorus of voices in this community highlighting the need for better health workforce policy and planning. This rose to a crescendo in the call to a recent all-party House Standing Committee on Health for the establishment of a pan-Canadian health workforce observatory. The idea of an organization that assembles health workforce data, information and expertise to inform more rational approaches to policy development has taken hold internationally. But would it alone make a difference here?

Canada would not be a leader in establishing such an observatory. Several other developed and developing countries have created organizations to compile, synthesize and translate the best evidence for health workforce decision-making. A similar federated system, Australia, for example, recently established Health Workforce Australia as a partnership of the Council of Australian Governments (similar to our federal-provincial-territorial organizations).

Developing nations, which face even more critical health workforce needs, have found such an organized approach critical to strengthening their health systems. Canada, which used to be recognized on the international stage as a leader in health workforce innovations, now looks to be a laggard. To its credit, the standing committee supported the call for an observatory in its recommendations but, sadly, the Government of Canada response did not even acknowledge the recommendation being made.

What might an observatory offer Canadians? A concentrated, coordinated and sustained effort to integrate health workforce planning, policy and reform in conjunction with complementary reforms to education and training.

We would have ready access to the best evidence to support health workforce innovations and to support those who must make the hard decisions about health workforce issues. An observatory would help to shift us away from crisis management towards an approach that is future-oriented.

But we will need more than an observatory if we are to avoid repeating past mistakes.

If a lack of evidence has not been the impediment to change to this point, then it will take more than an observatory to kick start real progress in the three areas identified by the Premiers last week. It will also take more than a pronouncement from the Premiers to force the cancellation of this soap opera.

There are no quick fixes when it comes to the health workforce, true. But if our leadership is committed to using the information that would be generated through an observatory, then it would be an important investment worth making.

Ivy Lynn Bourgeault holds the CIHR/Health Canada Research Chair in Health Human Resource Policy at the University of Ottawa. Morris Barer is the director of the Centre for Health Services and Policy Research, and a professor in the School of Population and Public Health, at UBC. Bourgeault and Barer are two of the three co-leads of the recently established pan-Canadian Health Human Resources Network.

Source: The Hill Times online

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