Perspectives 2017: Zubin Austin and Marie Rocchi

Dr. Zubin Austin & Marie RocchiUniversity of Toronto

Plenary II: The Experience of the HIRE IEHPs Initiative

The HIRE-IEHP Initiative

Zubin Austin PhD and Marie Rocchi MEdUniversity of Toronto

(on behalf of a cast of thousands)

HIRE IEHPs

HealthforceIntegrationResearch andEducationforInternationally EducatedHealthProfessionals

Background

• Skills shortages in health professions as a media (then public policy) problem in the 1990s – issues of access for patients• Emergence of social justice/equity concerns regarding under-

utilization of well-educated immigrants• Recognition of systemic barriers at the pre-licensure level• Need to maintain public confidence in knowledge and skills of all

health practitioners

….a delicate and challenging balancing act

Background

• Development of pan-professional coalitions of regulators, educators, employers, professional associations to align efforts related to both skills shortages and “the problem” of IEHPs• Emergence of bridging education programs to support social and

professional integration• Development of institutions (e.g. CEHPEA (as it was then known)) • Interprofessional partnerships to align efforts in areas of common

interest (e.g. Orientation to the Canadian Healthcare System)• General interest in ensuring as many IEHPs as possible could progress

to licensure with appropriate supports

How times change….

On the supply side:- Post 2008-recession results in more health professionals working

longer than expected- Increasing numbers of health professionals graduating within Canada- Increasing numbers of Canadians who Studied Abroad (CSAs)

returning homeOn the demand side:- Evolving scope of practice of many professions shifts demand curve- Increasing complexity of health care delivery emphasizes

interpersonal and communicative competency- Risk mitigation around hiring practices

The development of the HIRE IEHPs initiative

• Evolved during a time of labour surplus in many professions• Response to anecdotes regarding differential career trajectories of

IEHPs and Canadian graduates• Issues remain with mal-distribution of healthcare workforce, despite

apparent labour surplus• Increasing concerns expressed by regulators regarding risk mitigation

and the issue of institutional/cultural “fit”• An opportunity for the Health Force Ontario Marketing and

Recruitment Agency (HFO-MRA) and University of Toronto (U of T) to partner using complementary skills and resources to support workplace integration

What was the problem we were trying to solve?

• Getting a license is NOT the end of the story for most IEHPs• Systemic barriers persist within workplaces, which may be beyond

the purview of the OFC or other agencies• These barriers may result in chronic underemployment of IEHPs• Some IEHPs expressed concerns related to cultural integration

outside large urban centres, despite the availability of good-quality jobs• Issue of “Canadian experience wanted” manifests in different ways • Systems for supporting IEHPs which had evolved during a time of

skills shortage seemed uniquely ill-equipped to manage the reality of a time of skills surpluses

Initial Research Findings

• Used an evidence-informed approach to development of curricular tools/resources to support IEHPs and workplaces• Objective was to develop a suite of online resources and supports to

address gaps and needs and identified by diverse stakeholders• Partnership with HFO-MRA was crucial to not only understanding

dimensions of the post-licensure integration issues but to support dissemination and uptake of resources

Initial Research Findings

Employers:• Risk mitigation dominated hiring decisions: high-profile cases of socio-

cultural and linguistic misalignments negatively sensitized some employers• Workplace integration concerns dominated reasoning related to hiring

decisions, yet specifics of “fit” were frequently hard to explain or define• Skills surplus environment resulted in less emphasis on and lower

priority for IEHPs• Employers expressed need for a clear “business case” and workplace

supports related to hiring IEHPs• “A license simply means you’ve met some arbitrary minimum

competency requirement – we want and expect our staff to do better than just minimum competency.”

Initial Research Findings

IEHPs:• Systemic barriers to hiring are real, painful, and confusing• Few supports available post-licensure• Concerns about leaving larger urban centers • Recognition that licensure doesn’t guarantee workplace fit, but

frustrated by lack of available resources/supports post-licensure• Pattern of underemployment post-licensure and relegation to lower-

level jobs in the profession

Initial Research Findings

General:• On-boarding of ANY new staff member is a difficult process: this is

not an IEHP or CSA issue alone• Cultural fit (or “synchronicity”) is a dominant determinant of hiring

decisions and ultimately success in the workplace• Minimum fluency requirements and licensure examinations are not

reliable predictors of workplace success• “Better to have an unfilled vacant position than the wrong person for

the job”: increase in temporary or precarious professional employment not simply limited to IEHPs or CSAs• Diminishing public attention and no formal scrutiny of post licensure

issues

Initial Research Findings

Alternative Careers:- Emerged as a key issue for both employers and IEHPs, both at the

pre- and post-licensure stage- Traditional skills-matching approaches highly unsatisfactory; this is a

highly complex psychological adaptation process requiring individual attention…and time- Career decision making is not a linear or forward process;

pragmatism and pride constantly jockeying for supremacy- Tension between desire for cost saving/efficiency to produce a self-

serve on-line repository of tools and the reality of the need for one-to-one support and counselling

Where we are today

The HIRE IEHPs Initiative- Funded by Health Canada and administered through an agreement

with the Province of Ontario- Partnership with HFO-MRA and University of Toronto- Multifactoral interventions designed to support integrations of IEHPs

in the Canadian workforce through diverse evidence-informed strategies- Three core on-line resources to be used by IEHPs, employers,

settlement agencies, employment counsellors/coaches…and anyone else (including domestically educated health care professionals)

PReP

• Practice Readiness e-Learning Program• Designed around existing University of Toronto curriculum focused on

communication skills, cultural competency, and management of challenging clinical situations• Use of diverse on-line learning strategies including self-assessment,

self-reflection, video-trigger, reading, clinical vignettes, personal stories, etc.

WIN

• Workplace Integration Network• Initially designed around findings of employer-based research related

to barriers and facilitators to hiring of IEHPs; evolved into suite of generally applicable on-boarding resources with particular emphasis on issue of culture, communication, and integration• Use of diverse on-line learning strategies including video-trigger,

clinical/workplace vignettes, games, readings, etc.

ACP

• Alternative Careers Program• Built around recognition that the process of “losing” one’s primary

professional identity is a complex, psychologically fraught process• Grounded in vocational counselling theory related to decision

making, grief, loss, and adaptation• Use of case studies and comparators to support self-identification in

new roles, while still providing support for skills-matching type activities

Accessing HIRE IEHPs: www.hireiehps.com

Landing Page: www.hireiehps.com

Practice Readiness e-Learning Program (PReP): Communication Matters• Series of 16 online courses geared towards IEHPs

• Video-based: vignettes, subject matter experts, narration • Learning activities: self-reflections, quizzes, games (e.g. matching) • Additional resources provided for each course• Evaluation surveys embedded in courses• Completion time: 30-60 minutes per course

• Courses focus on communication, workplace issues, and challenging situations in Canadian healthcare context to support successful workplace integration

PReP: Course TopicsPart 1: Foundations Part 2: Advanced Part 3: Workplace Matters

Course 1: Working in Teams Part 1 – Teamwork and the Patient Experience

Course 6: Part 1: Palliative Care 2 – Autonomy and Choice

Course 11: A Primer on Employment Law for Employees

Course 2: Interpersonal Conflict and Conflict Resolution

Course 6: Part 2: Palliative Care 3 – The Healthcare Provider as Patient Advocate

Course 12: The Interview Process

Course 3: Diversity Course 7: The Aging Population Course 13: Working in Teams Part 2 – Collaboration in the Workplace

Course 4: Pandemic: Communication in Stressful Situations

Course 8: Pain – Communication and the Patient Experience

Course 14: Error Disclosure and Apology

Course 5: Palliative Care 1 – Communication and the Patient Experience

Course 9: Gender, Sexuality and Identity Course 15: The Feedback Process

The Bridge (Transition) Course 10: Indigenous Peoples of Canada: Stories and Experiences

Course 16: Workplace Culture and Integration

Accessing PReP: www.hireiehps.com

PReP: Courses

PReP: Courses

Videos, Reflections, Quizzes

PReP and WIN: Log in to track progress

Workplace Integration Network (WIN)

• Series of 9 online courses for employers, human resource managers, supervisors, and employees working with IEHPs• Versatile use: independent learning, staff development, workshop format• Video-based: vignettes, subject matter experts, narration • Interactive quizzes/exercises, reflective questions, tools/templates, resources• Evaluation surveys embedded in courses• Completion time: 15-30 minutes per course

• Courses focus on practical topics to support hiring and successful integration of IEHPs into the workplace• Topics rated highest for potential end-users: cultural diversity in the workplace,

“plain language” communication, interviewing, legal rights and responsibilities

WIN: Course TopicsCourses TopicsCourse 1 Building a Business Case for Hiring and Integrating IEHPsCourse 2 Understanding the IEHP PerspectiveCourse 3 International Academic and Professional CredentialsCourse 4 Professional Regulatory BodiesCourse 5 Part 1 – Open CommunicationCourse 5 Part 2 – Developing an Inclusive Writing StyleCourse 6 Part 1 – Creating a Positive Work EnvironmentCourse 6 Part 2 – A Primer on Employment Law for EmployersCourse 7 Diversity and IntegrationCourse 8 Working in TeamsCourse 9 Workforce Health

Accessing WIN: www.hireiehps.com

WIN: Courses

Course View, Video-Based Courses

Quizzes, Reflections, Exercises

Accessing ACP: www.hireiehps.com

Alternative Careers Program (ACP)

• Series of modules and tools that allow IEHPs to explore alternative career options outside of the regulated health profession in which they were originally trained• Goal to support IEHPs in obtaining gainful alternative careers and

successfully integrating into the Canadian workforce• Self-directed by IEHP or guided by HFO Advisor or Counsellor• Evidence-Informed Program

• Participatory program design • Based on vocational psychology/career counselling literature and

instructional design principles

ACP: Key Literature Findings

• LIM Consulting Associates – research report recommendations included:1

• Creating a central repository of alternative career resources• Developing a series of illustrative alternative career case studies

• Chen, C. P.2

• Cross-Cultural Life-Career Development framework for career counselling with immigrants; importance of self-concept, life-career integration, human agency, contextual awareness, and resiliency

• Novak, L. & Chen, C. P.3

• Described helping strategies for foreign-trained professionals to increase self-efficacy, provide local knowledge, advocate, and promote acculturation

• Savickas, M. L.4

• Narrative constructivist approach to career counselling; construct career through small stories, deconstruct, reconstruct, and co-construct future career with client

1LIM Consulting Associates. (2013). Foreign qualification recognition and alternative careers: Report submitted to the best practices and thematic task team of the foreign qualifications recognition working group. Retrieved from http://novascotia.ca/lae/RplLabourMobility/documents/AlternativeCareersResearchReport.pdf. 2Chen, C. P. (2008). Career guidance with immigrants. In J. A. Athanasou & R. Van Esbroeck (Eds.), International handbook of career guidance (pp. 419–442). Toronto: Springer Science. 3Novak, L. & Chen, C. P. (2013). Career development of foreign trained immigrants from regulated professions. International Journal for Educational and Vocational Guidance, 13(1), 5–24. 4Savickas, M. L. (2011). New questions for vocational psychology: Premises, paradigms, and practices. Journal of Career Assessment, 19, 251–258.

• 10 Integrated Virtual IEHP Cases – exploratory interactive online cases• Demonstrate (through narrative) alternative career pathways and resources• Elicit self-reflection around alternative career options and decision-making

• 6 Online Modules – wrap-around virtual cases and resources• Evaluation surveys embedded in modules• Certificates of completion available• Completion time: 1-2 hours per module

• Database of Resources for Alternative Careers• Includes self-assessment tools, existing resources on alternative careers,

career exploration websites, etc.

ACP: Career Options e-Resource

Landing Page, Modules

ACP: Virtual Cases at a Glance

Logging in to ACP

Book Layout, Resources, Certificates

Virtual IEHP Cases

Virtual IEHP Cases

ACP: Advisor and Staff Manual

• To support advisors, counsellors, and staff using ACP with IEHPs• Includes descriptions of content, activity guide, reflective questions,

and tips for use with clients

Program Evaluation

• Online Course/Module Exit Surveys• Satisfaction with content – value, utility, learning outcomes• User experience – access, navigation, design/organization • Demographic information – e.g. profession, length of time in Canada (IEHPs)• ACP: Readiness to pursue alternative careers

• Follow-up survey, IEHP focus groups, key informant interviews• Pilot testing• Ongoing feedback from Health Force Ontario and end-users• Continuous improvement based on evaluation feedback

Current State

• PReP: 12 courses available • WIN: 6 courses available• ACP: All modules available • Coming Soon…

PReP WINWorking in Teams Part 2: Collaboration in the Workplace

Building a Business Case for Hiring and Integrating IEHPs

The Interview Process Understanding the IEHP PerspectiveError Disclosure and Apology Open CommunicationThe Feedback Process Creating a Positive Work Environment

Working in Teams

HIRE IEHPs: Using the Site

• Online platform allows access to PReP, WIN, and ACP• Open access• Create an account

(username/password) to track progress and complete surveys in PReP and WIN: optional• Account must be

created for ACP

Conclusion

• A suite of online resources has been developed for use by multiple end users, including IEHPs, employers and advisors/counsellors• Open access – all modules to be available by end of March 2017

2017 Perspectives SymposiumMarch 2, 2017

#Perspectives2017