HEALTHCARE WORKFORCE PLANNING
Thomas C. Ricketts, III, Ph.D. Learning Objectives
After completing this chapter, the reader should be able to
• trace the history of human resources for health and workforce planning; • learn why and when workforce planning is undertaken; • briefly describe the five major methods used in workforce planning; • understand the key concepts of benchmarking, adjusted needs, and
demand as they apply to workforce planning; • develop a simple estimate of the future supply of a profession for a
population; and • interpret the results of workforce planning reports as they relate to
individual healthcare organizations and delivery systems.
Most of this book views human resources management (HRM) from the per- spective of the healthcare organization. Chapters focus on such topics as job design, recruitment and retention, and evaluation of individual performance. However, organizations are also affected by the larger external environment in which they are situated. In HRM, broad workforce policy and labor market factors, which are external aspects, affect an organization’s ability to attract and retain employees. An organization may have a theoretically sound recruitment program for nurses, but if sufficient numbers of nurses are not being trained in the national healthcare system, the program will likely prove unsuccessful.
This chapter’s focus is unique among the chapters in this book in that it addresses workforce planning for communities, regions, states, countries, and other jurisdictions. It devotes attention to the healthcare workforce needs throughout society rather than the needs of a particular organization.
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Human resources for health (HRH) workforce planning deals with questions, including the following:
• How do we determine the number of surgeons needed in a particular geographic area?
• What factors help us to best anticipate future supply and need for various types of healthcare workers?
• What methods are used to project future workforce needs? What are the strengths and weaknesses of different approaches, and how may they be most effectively applied?
This chapter, therefore, takes a macro-level perspective on the healthcare workforce and examines concepts and methodologies that are useful in pro- jecting workforce requirements for communities and larger regions. Much of the remainder of this book focuses on internal strategies for managing human resources, which we can view as micro-level approaches, and addresses work- force concerns from the perspective of a single organization.
Workforce planning is the assessment of needs for human resources. This process can be very formal and complex or depend on “back-of-the-envelope” estimates and can be applied to small organizations or practices as well as to national and international healthcare delivery systems. Workforce planning fits in with overall health systems planning and human resources development and management. One conceptualization sees workforce planning as one of three steps in workforce development (De Geyndt 2000):
1. Planning is the quantity concern. 2. Training is the quality concern. 3. Managing is the performance and output concern.
The Australian Medical Workforce Advisory Committee (2003) de- scribes workforce planning succinctly: “ensuring that the right practitioners are in the right place at the right time with the right skills.” However, the consen- sus remains that workforce planning is “not an exact science” (Fried 1997).
Workforce planning is used to support decision making and policy de- velopment for a wide range of concerns. For healthcare organizations to meet their clinical and operating goals and objectives, they must effectively deploy and support workers of all kinds. Doing so requires that the numbers and types of workers match the needs of the patients, regulators, and payers who make up the functional environment of the healthcare organization. For state, provincial, and regional or national systems, policymakers also require infor- mation from planning processes that include workforce projections and assess- ments. Functionally, workforce planning does several things:
• Interprets tasks and roles • Establishes education and training needs
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• Explains the dynamics of the workforce • Describes and disseminates information about workforce and workplace
change • Defines and identifies shortages and surpluses
The History of Healthcare Workforce Planning
HRH planning dates back to the origins of organized medicine and health- care. Military planners recognized the need to provide adequate numbers of caregivers for wounded and ill soldiers, and very rough assessments of the requirements for qualified medical workers were part of the preparation for military campaigns. The healthcare system in the Soviet Union, and later in socialized nations, made use of systemwide planning (which includes an es- timate of the numbers and types of workers) in structuring healthcare. As European democracies moved toward national healthcare insurance sys- tems, they recognized the need to balance their policies for training and preparing healthcare workers with the anticipated needs of the covered pop- ulations. Given the importance of human resources to healthcare systems and the examples of planning that were in existence, it was still possible for an expert group to observe that “only very recently has there been more of a substantive debate about this issue internationally” (Dubois, McKee, and Nolte 2006). While HRH planning has a fairly rich history within individ- ual nations and among international bodies like the United Nations, it has received little reflection in most other countries. The United States offers an exception.