Why Does it Take a Crisis to Understand That Health Workers Are Our Health System?

By Ivy Bourgeault, Sarah Simkin and Caroline Chamberland-Rowe

In country after country, members of the public are clapping from their doorways and balconies to show their appreciation of health workers. It is becoming clearer than ever that our health system is largely our health workers.

Ventilators do not work without health workers; testing does not happen without health workers. All forms of care required to respond to this crisis will require health workers.

Health system capacity – of which health workers are a key component – is often represented as a flat line on epidemic curves. The main aim of flattening the curve is to keep demand below the upper limit of health system capacity. This flat line gives the impression that health system capacity is static. It is not.

Social distancing is a way for us to help moderate the demand side of the equation, but how are we to bolster the capacity side of the equation to keep ahead of that curve?

Ongoing analyses of health system capacity are modelling increased capacity of physical resources. What is unclear is whether these analyses are modelling health workforce capacity, and if so, how.

Health workforce capacity is not simply the number of doctors, nurses, respiratory therapists or other essential health workers that are actively registered. What health workers are allowed to do (their scopes of practice) and how they do it (their practice patterns) can vary substantially, depending on the populations they care for, the settings in which they work and the regulations by which they are governed.

But health workforce modelling should not only model how work is typically done. In times of crisis, when systems are called upon to demonstrate resilience, responsiveness, and surge capacity, models need to take into consideration how work could be done and demonstrate what capacity could be mobilized through more optimal use of available resources.

That is, how could we better utilize the whole of the health workforce to turn the capacity line upwards?

Responding to this crisis will require shifting tasks and leveraging the full scope of skills available within the health workforce. These innovations are often employed in low resource settings, out of necessity, but even high-income countries are quickly shifting tasks and redeploying available human resources.

In the UK, for example, anyone with skills in sedation, including dental nurses who are part of the National Health Service are being recalled to help respond to the COVID crisis. In Australia, physiotherapists are similarly being redeployed to work in acute respiratory teams. Additional pools of health workers, such as trainees and retirees, are being mobilized.

To best accomplish this, we need to know who is in the health workforce, where they are, and what skills they have. Sounds straightforward — and yet, in Canada, these basic data are often fragmented, out of date or hard to access.

With better data infrastructure and coordinated health workforce planning, we could proactively address inadequacies in the system and develop the flexibility necessary for the workforce to respond effectively to pandemic situations.

We need to be building this infrastructure now.

It is time for custodians of health workforce data – regulatory authorities, insurers, employers, health professional associations, educational institutions and all levels of government – to cooperate in the collection and sharing of information about the health workforce.

Processes and pathways that emerge out of necessity should be maintained and developed after the crisis has passed in order to leverage this crisis as an opportunity for system strengthening. The performance of our health system – during this pandemic and beyond – depends upon high quality and timely data to support decision-making.

By prioritizing health workforce data and infrastructure, we will be able to better maintain the well-being and productivity of our health workers. We will be able to protect their physical safety by predicting who is going to need personal protective equipment and ensuring that this critically important equipment gets to workers when and where they need it. We will also be able to promote their psychological health and safety by planning for sustainable workloads and appropriate supports.

Now more than ever we need to show our valuable health workers our support by explicitly including them in the capacity planning equation, and implementing protective policies and practices. Otherwise, we’re left with one hand clapping.

Previously published on permission.


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Photo credit: iStockphoto.com

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