Exploration of workforce changes in integrated chronic care: Findings from an interactive and emergent research design

Abstract

IntroductionIntegrated care interventions introduced in response to the increased demand for long-term care entail profound changes to the health workforce. This exploratory study aims to provide an overview of the workforce changes implemented as part of integrated chronic care interventions.MethodsAn interactive and emergent research design was used consisting of a literature review, qualitative expert questionnaires and case reports. We defined integrated care as interventions targeting at least two of the six Chronic Care Model components. Workforce changes were defined as those changes experienced by clinical and non-clinical staff responsible for public and individual health intervention.ResultsSeven workforce changes were identified: (1) nurse involvement, (2) multidisciplinary staff, (3) multidisciplinary protocols/pathways, (4) provider training, (5) case manager/care coordinator, (6) team meetings, and (7) new positions. Most interventions included more than one of these workforce changes.ConclusionThe results of this study provide detailed insights into the current implementation of workforce changes in integrated care interventions and thereby pave the way for further investigations into the relative effectiveness of different workforce changes within the scope of complex interventions. Advancing knowledge in this area is essential for fostering health systems’ capacity to cope with the challenges related to the current demographic and epidemiological trends.

Barriers and Facilitators to Workforce Changes in Integrated Care

“…Due to the intended international scope and exploratory nature of the research, we opted for a questionnaire in order to increase our reach, instead of, for example, interviews or focus groups that would allow for gathering more in depth data, but would limit the range of experts that could potentially be included in the study. Furthermore, we only provided a written version of the questionnaire, as we did not expect that conducting the questionnaire by mail or telephone would contribute to increasing the response rate as respondents may have been unwilling or unable to pay the postage or speak a non-native language over the phone [32]. …”

Evaluation of a nursing and midwifery exchange between rural and metropolitan hospitals: A mixed methods study

“…Projects such as NMEP should be carefully considered as part of the workforce change that needs to occur, in order to meet healthcare needs. Importantly, NMEP has the potential to support collaborative practice between metro and rural areas; given the need to enhance the skills and knowledge of the rural nursing and midwifery workforce, and the clinical reciprocity required for the success of integrated models of care [13,52,53].…”

“…As the primary providers of care, nurses are often the professionals who help patients navigate the multiple services and specialities they require, across multiple regional and metropolitan centres [ 11 ]. Integrated care thus, has been described as essential, although the value of such care is reliant on an effective co-ordinator to manage it [ 12 , 13 ], which rural and remote nurses are proving to be effective at [ 14 – 16 ]. Greater transferability of the nursing workforce and the preparedness for managing care in a dynamic health care environment, provided within the framework of programs such as NMEP, become essential.…”

Rethinking workforce planning for integrated care: using scenario analysis to facilitate policy development

“…Health workforce planning seeks to ensure the right people receive the right services at the right place, at the right time, from those with the right skills [1] and at the right price or cost [2]. This task has become increasingly challenging for workforce planners as health care embraces increasing integration [3], as a future health workforces' configurations may not be known [4], may be quite different from those at present [5] and may require people to possess different or strengthened competencies [3]. These uncertainties are exacerbated by the current medical education settings, which do not cater well for the teaching of integrated care practices [6,7].…”