Workforce Prioritisation Tool

Providing Operational Advice Process into ER Negotiations

May 2012

Commenced 2009 Informing BSG development Lack of current tools available to DHBs to critically

evaluate the relationship between health workforces and the operation of wider systems / services

FW informants, A,T&S Strategy Group, prioritisation for 44+ workforces

Action research approach to development Rationale: consistency, standardised, endorsed,

adaptable approach Iterative development

Background

The need for more suitable frameworks for health workforce monitoring and development not new

Previous assessments have not taken a ‘whole of systems approach' nor provide a logical framework as to how workforces can be compared to each other or within a broader systems perspective

Ability to assess and classify health workforces whilst taking cognisance of the wider contextual factors which impact on the overall New Zealand health system

Move from anecdotal to more evidential view Provision of evidence to make better informed ER and

IR decisions, specifically with MECA agreements

Framework Requirements

Identify areas of operational pressure where intervention may be required

Use across multiple areas, service settings or with specific occupational group

Reliant on consensus achieved via focus group and cross section of expertise

Provision of rationale for further investigation to occur; Macro-Micro

Tool is time dependent - however has ability to repeat the process at a later date in order to review any changes or other such trends

Requirement: Screening Tool Design

Purpose to develop and validate a framework to allow classification of health workforces according to their current status within the New Zealand health system

Allows workforces to be examined from a system perspective as to whether they are stable or under pressure, offers potential to tailor funding to match the classification

Study further developed FW, in depth interviews DHBNZ, pilot testing, Delphi process over 3 months.

Research Component

Delphi Method, iterative process used to accumulate/refine anonymous opinions of experts using data collection and analysis techniques combined with feedback (Skulmoski, Hartman & Krahn, 2007).

Well suited method when there is incomplete knowledge about a problem

Interviews – DHBNZ 2011 Prototype – pilot testing Delphi – 3 round testing

Methodology

Five Domains

Service NeedService Stability

Model of Care /Clinical Processes

Public ProfilePublic Confidence

Political/policy contextLabour market

positioning

Supply Size & Distribution

Gender/ ethnicity /age

Operational FlexibilityRegulatory

Education & training Qualifications/Flexibility

Operational Capacity R & R

Lead in timeSpecificity of skills

Service Needs Public Profile Supply Operational Flexibility Operational Capacity

1 Service stable and no anticipated major changes to service demand in the short-term.

No current issues of public confidence or political/policy factors.

No major distribution or supply issues.

No current requirement for workforce flexibility for this occupational group. Some workforce substitution available.

No recruitment and retention issues.

2 Some instances of demand pressure on services but stable overall.

Some public confidence issues /policy issues appearing which may impact on the workforce.

Some distribution and /or supply issues emerging and wider issues with supply.

Emerging requirement to begin looking at innovation and role changes for this workforce and/or related workforce (substitution options).

Some recruitment and retention issues are occurring.

3 Service demand progressively increasing, impacting on overall service level or peak demand periods increasing.

Public confidence /political context /policy change is directly impacting on the workforce.

Distribution and/or supply issues increasingly impacting on wider system. Issues with overall size of workforce available.

There is a requirement for more flexible workforce options. Some substitution and/or workplace innovation reducing current pressures

Generalised recruitment and retention issues. Operational environment is affected by gaps in this workforce due to the specialised skills they have

4 Service operating at full capacity. Peaks in service demand driving instability in demand environment.

Public /political confidence in services is being actively impacted by absence of the workforce / or disruption to availability.

Significant distribution and or supply issues currently occurring. Overall available workforce supply is considered below replacement needs.

Requirement for flexible workforce options, but very limited/ no available substitute workforce that can perform the critical functions of this workforce.

Significant recruitment and retention issues . Scarcity of workforce is compromising operational environment.

Scoring Matrix

Overall Scoring 5-8 Stable Occupation:

WATCHING BRIEF

9-13 Transitional Occupation: SOME INTERVENTION RECOMMENDED

14-17 Transitional/ Occupation Under Pressure: INTEVENTION REQUIRED

18- 20 Occupation Under Pressure: INTERVENTION IMPERATIVE

Classification

  Identify scope of the assessment to be performed - usually

assessing a workforce as a whole but consideration can include particular domains that are relevant to the workforce(s) being discussed:

Whole of workforce: general consideration of a specific workforce e.g. nursing, midwifery

Professional Groupings: specific practice areas relevant to a particular work group

Specialities and sub-specialties: e.g. nursing such as medical, surgical, ED, Critical Care, operating theatre etc

Geographic: rural /urban; across regions Service /deployment based: medical, surgical, mental health etc Patient categories: hi / low dependency

Required Steps: 1. Identify scope of assessment

Agree facilitator Lead focus group discussion and facilitate the

process (selection, invitation of participants, scheduling , sending required info)

Write up of the focus group and overall findings – operational advice piece

Carry out any follow up investigation that is identified from conducting of the focus group.

2. Focus Group Facilitation

  Establish a focus group Sector health experts Multidisciplinary if possible, include adequate

representation from the workforce being discussed Approximately 10-20 participants in the focus

group in total Should include other professional, organisational

and operational representation to ensure all perspectives can be considered

Have a variety of geographical representation if conducting a national assessment of a particular workforce.

3. Focus Group Selection

Gather all available background information /data on workforce to help inform group discussion and ensure adequate preparation

Data should include relevant operational DHB, regulatory and strategic workforce information from Health Workforce New Zealand

Data template.

4. Background information relevant data on the workforce

Can be conducted either face to face or by teleconference. Teleconference is a preferred method and can facilitate the assessment tool process well

Approximately 60-90 minutes should be sufficient to conduct the process.

5. Conduct the focus group

The 5 domains Workforce classification – provide an

overview of the four potential outcomes of scoring; stable , transitional, transitional / underpressure, underpressure

Scoring matrix

6. Overview of Process & Booklet

Reconfirm final classification reached Reiterate any additional issues which have

arisen from group discussion that require further investigation as part of any ER/IR processes

Classification then provides a basis from which other discussions can be generated and also helps to provide direction on what areas are causing pressure or particular issues to workforce being reviewed.

7. Meeting Completion

Proposed ProcessOperational Advice Process

Gather Information Confirm Themes Refine Themes Agree

 Semi-structured Test Test

PreliminaryConversation using

Endorsement assessment tool  

Focus group members Focus Group Focus Group   

Employed workforce data and analysis / existing information, reports Bargaining

Strategy Group

Use of screening tool only one process Forms baseline data, helps generate further

investigation into particular workforce issues as warranted

Should never be used as an all encompassing definition / tool, but as a gauge or pointer for further work to occur

Attention should be given to ensure data gathering and other forms of workforce review are undertaken

Used a best proxy to link wide sector views, underpinned by operational evidence and HR data sources.

Disclaimer

1. Where should information (both operational and strategic) currently come from?

2. Focus group representation – who should be on the groups?

3. What other data could/should be collected?

Group Session: Key Questions

What worked, what didn’t? Information gathering conclusions

Focus group suggestions

Feedback

Build this into highly interactive tool and place online so that DHBs can use at the macro and possibly micro level as an input to carry out their workforce planning and not just limit to a feed into the employment relations and bargaining (panellist 15).

The real strength of this tool would be to scope all parts of the workforce and then use the appropriate part during bargaining (panellist 2)

Research Findings: Future Use

Need to identify a further part of the tool that serves to measure the “value” added by a workforce to the health system. It must link to an efficiency/productivity base so that we can demonstrate true value (panellist 7). 

Beneficial to establish a tripartite work group of representatives of (say) employers, unions and central government to achieve a common view of pressure points and priorities. This should be supported by an analytical unit and, if warranted, sub-work groups that would be focussed on specific workforces or perceived problematic areas (panellist 14).

A system that makes prioritisation transparent is important, although still vulnerable to political will. The above would assist in reflecting a bargaining strategy environment where trade-offs are made in the light of both quantitative measurement but supported also by qualitative feedback. An example of this would be the value of “MRTs” as a collective grouping in the provision of diagnostic services versus the patient journey around say cancer treatment (panellist 5).

Future Use Continued

One thing that would significantly increase the value of this type of prioritisation framework in an ER/IR context would be to apply the framework to all health sector workforces at the same time, at a point identified as the ‘beginning’ of the bargaining round (accepting that the cyclical nature of bargaining could make the identification of a beginning somewhat arbitrary)...would mean that when the health sector is considering where to best invest the limited additional funding available, this would be informed by operational and strategic workforce imperatives across the sector and could be targeted accordingly (panellist 11).

At present, with the framework being applied to specific workforce groups as their collective agreements come up for renewal, there is not an overarching sector-wide view of the various workforce priorities against each other (panellist 10).

A standard tool such as this will ensure consistent measurement across and between workforces and should enable prioritisation and planning based on risk, and anticipated change (panellist 8).

Future Use continued

Links to productivity measures as a means of comparison of workforces was also suggested

Feedback re the need to combine both quantitative and qualitative measurement in any approach to workforce prioritisation in the ER/IR context and to ensure that one measurement was not prioritised above another

Further Research

Tool be further developed and undergo wider sector testing. Could allow sector embedding and engagement as well as build on current findings

The framework be used with all MECA renewals. Use as a standardised tool as it could ensure consistent measurement across and between workforces and could enable prioritisation and planning based on risk and anticipated change

Could be applied to all health sector workforces at the same time, therefore allowing identification at the beginning of the bargaining round.

Recommendations