Policy-makers running the risk of over-reaction
After the mid-January meeting of the Premiers on the future of Canadian health care came the announcement of the creation of a working group on health care innovation to examine three critical issues related to the health workforce.
These issues include examining the scopes of practice of health care providers to better meet patient needs, better coordinated management of health human resources and accelerated adoption of clinical practice guidelines (CPGs).
Typically, the public dialogue around the health workforce is narrowly focused on addressing shortages and other supply related crises, real or imagined, so it is refreshing to see attention paid at this level to broader health workforce issues.
We are all familiar with the now common political promise of more doctors and nurses. And at least in the case of doctors, we are well along the road to fulfilling that promise, in spades – first year enrolment in Canadian medical schools is now 80 per cent higher than a decade ago.
Indeed, policy-makers are running the risk of over-reaction. Many commentators on the state of health care in Canada have noted that we are not so much suffering from a lack of health care professionals as from their inappropriate deployment.
In other words, we could be doing more, and better, with existing resources.
Increase nurse practitioners in primary care
But before we get too excited about this latest political announcement, a bit of historical context is important. Scopes of practice, coordinated management and CPGs have all come under a variety of committee, task force, working group and Royal Commission lenses over the past two decades. As important as that work has been, there has been a frustrating lack of follow through or haphazard implementation on what are often a series of well crafted, evidence-based recommendations.
Health workforce issues are health care policy’s greatest soap opera.
Skip a decade and then pick up the thread, and you’ll feel right at home in the midst of the same recurring issues. We have known from research based in Canada and elsewhere, now almost 40 years old, about the huge potential for nurse practitioners in primary care. Yet implementation of this single evidence-based policy recommendation continues to be hamstrung by a maddening mix of professional resistance and lack of political will.
Instead, we train ever more physicians, and continue to wonder why we have trouble ensuring adequate supply of primary care in smaller communities.
This history of failed implementation of thoughtful recommendations is readily apparent to the various health workforce stakeholders who have been around for any length of time.
There is now a chorus of voices highlighting the need for better health workforce policy and planning. This rose to a crescendo in the call to a recent all-party Parliamentary Standing Committee on Health for the establishment of a pan-Canadian health workforce observatory.
The idea is to establish an organization that would assemble health workforce data, information and expertise to inform more rational approaches to policy development and health workforce deployment.
Several other developed and developing countries have created such organizations to compile, synthesize and translate the best evidence for health workforce decision-making. Developing nations, which face even more critical health workforce needs, have found this organized approach critical to strengthening their health systems.
Canada, which used to be recognized on the international stage as a leader in health workforce innovations, now looks to be a laggard. To its credit, the Standing Committee supported the call for an observatory in its recommendations but, sadly, the Government of Canada response did not even acknowledge that the recommendation had been made.
What might an observatory offer Canadians?
First, it would offer a concentrated, coordinated and sustained effort to integrate health workforce planning, policy and reform in conjunction with complementary reforms to education and training.
Second, we would have ready access to the best evidence to support health workforce innovations and to support those who must make the hard decisions about health workforce issues. An observatory would also help to shift us away from crisis management towards an approach that is future-oriented.
There’s no quick fix for health care workforce woes
But we will need more than an observatory if we are to avoid repeating past mistakes.
A lack of evidence has not been the impediment to change to this point. Therefore, it will take more than an observatory to kick start real progress in the three areas identified by the Premiers. Soap operas are “sticky” for a reason.
There are no quick fixes when it comes to the health workforce, true. But if our political leadership is committed to using the information that would be generated through an observatory, then it could be an investment offering substantial returns.
Ivy Lynn Bourgeault holds the CIHR/Health Canada Research Chair in Health Human Resource Policy at the University of Ottawa and is an expert advisor with EvidenceNetwork.ca. Morris Barer is the Director of the Centre for Health Services and Policy Research, and a Professor in the School of Population and Public Health, at UBC.