Rethinking health workforce planning: Capturing health system social and power interactions through actor analysis

Rees, Gareth H; Crampton, Peter; Gauld, Robin; MacDonell, Stephen G.

doi:10.1016/j.futures.2018.03.009

Cited by 16 publications

(17 citation statements)

References 59 publications

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“…Developing these governance capabilities and structures may require deeper and more analytical methods than simple stakeholder analyses to gather data for strategy and implementation [54]. Rees et al [44] found that New Zealand’s workforce actors in different health sectors have divergent perceptions and priorities for workforce evolution, suggesting care should be taken when considering policy situations involving multiple actors.…”

Section: Discussion and Evaluationmentioning

confidence: 99%

“…Moreover, while the use of teams containing diverse staff and skills has been found to have a positive effect on care quality and patient satisfaction [55], there are traditions surrounding professional training, regulation and practise that result in institutional inertia preventing wider spread change [56]. It is here that attention needs to be paid to the roles of health workforce actors and targeting policy to lever effective system change [44]. Complementing this is continued to engagement with clinicians, educators and employers to achieve future care models [36] while recognising the limiting effects of professional resistance [38].…”

Section: Discussion and Evaluationmentioning

confidence: 99%

“…These failings have been attributed to policy and accountability tensions due to HWNZ’s position as part of the NHB, while being reliant on MoH resources [42]. The fragmented nature of health care, the discipline-based lens’ of New Zealand’s workforce participants [21, 22, 30, 43] and their conflicting priorities [44] may also have contributed.…”

Section: Case Descriptionmentioning

confidence: 99%

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The evolution of New Zealand’s health workforce policy and planning system: a study of workforce governance and health reform

Rees

2019

Hum Resour Health

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Introduction While considerable attention has been given to improving health workforce planning practice, few articles focus on the relationship between health workforce governance and health reform. By outlining a sequence of health reforms, we reveal how New Zealand’s health workforce governance and practices came under pressure, leading to a rethink and the introduction of innovative approaches and initiatives. Case description New Zealand’s health system was quite stable up to the late 1980s, after which 30 years of structural and system reform was undertaken. This had the effect of replacing the centralised medically led health workforce policy and planning system with a market-driven and short-run employer-led planning approach. The increasing pressures and inconsistencies this approach produced ultimately led to the re-centralisation of some governance functions and brought with it a new vision of how to better prepare for future health needs. While significant gain has been made implementing this new vision, issues remain for achieving more effective innovation diffusion and improved integrated care orientations. Discussion and evaluation The case reveals that there was a failure to consider the health workforce in almost all of the reforms. Health and workforce policy became increasingly disconnected at the central and regional levels, leading to fragmentation, duplication and widening gaps. New Zealand’s more recent workforce policy and planning approach has adopted new tools and techniques to overcome these weaknesses that have implications for the workforce and service delivery, workforce governance and planning methodologies. However, further strengthening of workforce governance is required to embed the changes in policy and planning and to improve organisational capabilities to diffuse innovation and respond to evolving roles and team-based models of care. Conclusion The case reveals that disconnecting the workforce from reform policy leads to a range of debilitating effects. By addressing how it approaches workforce planning and policy, New Zealand is now better placed to plan for a future of integrated and team-based health care. The case provides cues for other countries considering reform agendas, the most important being to include and consider the health workforce in health reform processes.

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Section: Discussion and Evaluationmentioning

confidence: 99%

Section: Discussion and Evaluationmentioning

confidence: 99%

Section: Case Descriptionmentioning

confidence: 99%

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The evolution of New Zealand’s health workforce policy and planning system: a study of workforce governance and health reform

Rees

2019

Hum Resour Health

Self Cite

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“…One proposal to improve on this is to promote the commitment of all professionals and sectors in the policy development process [93]. Though often as not, patients are left out of policy or health planning, or, have little influence even when canvassed [60]. This would indicate that better engagement and involvement processes for patients and their families is required when attempting to integrate care and its service design and policy development processes.…”

Section: Discussionmentioning

confidence: 99%

“…Our second source of data was taken from Rees et al [60], which provided sufficient data and variations to construct a range of exploratory scenarios [41]. Taking the OPH data from this actor analysis of two New Zealand's health system sub-sectors, provided us with the identification of critical factors for the future OPH workforce, the relative power of actors within the system and the divisiveness of identified issues.…”

Section: Scenario Methodsmentioning

confidence: 99%

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

Rees

Crampton

Gauld

et al. 2020

BMC Health Serv Res

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Background: A goal of health workforce planning is to have the most appropriate workforce available to meet prevailing needs. However, this is a difficult task when considering integrated care, as future workforces may require different numbers, roles and skill mixes than those at present. With this uncertainty and large variations in what constitutes integrated care, current health workforce policy and planning processes are poorly placed to respond. In order to address this issue, we present a scenario-based workforce planning approach. Methods: We propose a novel mixed methods design, incorporating content analysis, scenario methods and scenario analysis through the use of a policy Delphi. The design prescribes that data be gathered from workforce documents and studies that are used to develop scenarios, which are then assessed by a panel of suitably qualified people. Assessment consists of evaluating scenario desirability, feasibility and validity and includes a process for indicating policy development opportunities. Results: We confirmed our method using data from New Zealand's Older Persons Health sector and its workforce. Three scenarios resulted, one that reflects a normative direction and two alternatives that reflect key sector workforce drivers and trends. One of these, based on alternative assumptions, was found to be more desirable by the policy Delphi panel. The panel also found a number of favourable policy proposals. Conclusions: The method shows that through applying techniques that have been developed to accommodate uncertainty, health workforce planning can benefit when confronting issues associated with integrated care. The method contributes to overcoming significant weaknesses of present health workforce planning approaches by identifying a wider range of plausible futures and thematic kernels for policy development. The use of scenarios provides a means to contemplate future situations and provides opportunities for policy rehearsal and reflection.

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Decision process: A stakeholder-oriented video conferencing software selection in sustainable distance education

Yilmaz,

Karadayi-Usta,

Yanik

et al. 2024

Decision-Making Models

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Rethinking health workforce planning: Capturing health system social and power interactions through actor analysis

Cited by 16 publications

References 59 publications

The evolution of New Zealand’s health workforce policy and planning system: a study of workforce governance and health reform

The evolution of New Zealand’s health workforce policy and planning system: a study of workforce governance and health reform

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

Decision process: A stakeholder-oriented video conferencing software selection in sustainable distance education

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