The health workforce is a vital aspect of health systems, both essential in improving
patient and population health outcomes and in addressing contemporary challenges such
as universal health coverage (UHC) and sustainable development goals (SDGs). There
is an increasing body of research that indicates that if the health workforce were
to be redesigned from the ground up—based on population needs—we would see a very
different configuration of the health workforce. This makes us wonder how one could
design or develop innovative health workforce solution(s) for the future in order
to make the health workforce more responsive to population needs.
The 21st century presents several challenges to the health workforce and the health
professions that require thoughtful consideration and analysis. Health inequalities
continue to exist both within and across countries, especially affecting vulnerable
and disadvantaged groups. Disease patterns are changing, with a rise in chronic conditions
and non-communicable diseases, the COVID-19 pandemic notwithstanding. Increased life
expectancies also present us with the challenge of meeting care provisions for an
ageing population. Workforce shortages, geographic maldistribution, and international
migration are omnipresent.
Health workforce solutions have been diverse and generally dependent on condition,
context, or country-specific scenarios. New health occupations, as well as reforming
the scopes of practice of existing occupations, have been widely debated as solutions.
Of importance has been how different health personnel groups can work collaboratively
as a team, and at different levels of care—primary, secondary, and tertiary. Models
of care specific to population groups (e.g., Indigenous peoples, children, or older
people) as well as health conditions (e.g., cancer or oral health), and health strategies
(e.g., rehabilitation) are emerging, with varied success.
In this special issue of the International Journal of Environmental Research and Public
Health, we have brought together research that debates and provides innovative health
workforce solutions directed towards meeting population needs, mainly through integrated
solutions or models of care. We have also included papers that cover challenges at
an education or regulatory level. This special issue, entitled “The Future Health
Workforce: Integrated Solutions and Models of Care”, features a compelling range of
research that spreads across the health professions, including medicine, nursing,
dentistry, and allied health. This edition embraces quantitative as well as qualitative
research approaches, as well as methodological pluralism and a rapid review. A hallmark
of each article is methodological rigor, and we are particularly pleased to have included
research conducted with health workforce groups dealing with different conditions
in a range of contexts and countries including the USA, the UK, Canada, Australia,
Sweden, South Korea, Japan, China, and Brazil. This special issue features 13 papers.
The first research paper, from a multidisciplinary team of researchers based in the
Rural Clinical School in the Faculty of Medicine at the University of Queensland in
Australia, provides a theory that assists us to understand factors that affect doctors
in choosing a generalist or specialist medical career [1]. Belinda O’Sullivan and
colleagues’ theory shows us that the decision-making process involves multi-level
contextual factors that intersect with triggers that produce a career preference.
Both clinical and context-specific exposures, as well as attributes, skills, norms,
and the status of generalist and specialist fields affects choice. These factors combine
with doctors’ interests and expectations, including their professional values, and
perceptions about socio-economic and lifestyle rewards. It is interesting to note
too, that these factors and considerations intersected with social circumstances,
most especially gender and life stage.
The second article reports research conducted with the health services management
workforce in China [2]. The starting point for the study by Zhanming Liang and colleagues
is the fact that the traditional recruitment approach relied on clinical performance
and seniority, which provided little incentive to improve competencies. The study
utilised validated management competency assessment tool that was administered to
directors and deputy directors of medical services (n = 295) in three categories of
hospitals. The survey revealed that the informal and formal education received by
medical leaders in these Chinese hospitals has not been effective in developing the
required medical and leadership management competencies. This provides a basis for
recommendations regarding health system and higher education strategies to improve
the management competencies of clinical leaders in China.
We then turn to a thematic analysis of Twitter data and newspapers extracted through
a search for new forms of team work in the health and social care of older people
in response to the COVID-19 pandemic [3]. The study conducted out of University College,
Dublin in Ireland, identified rapid transformations in ways of working, including
innovations in telehealth, and in using online platforms to facilitate team meetings.
Interestingly, much of the change was attributed to goodwill as a response to the
pandemic.
Catherine Cosgrave’s study addresses chronic workforce shortages and unmet health
care needs in rural and remote communities in Australia [4]. The findings from this
qualitative study (semi-structured interviews with 74 executive staff, managers, and
allied health professionals) revealed factors influencing the recruitment and retention
of allied health professionals in rural public sector health services in Australia.
The study emphasises the value of a ’whole-of-community approach’ that supports individual
allied health professionals and their families to adjust to a new place and develop
a sense of belonging in a new community.
The next paper in this special issue reports a national cross-sectional study of faculties
supporting general medical practitioners (GPs) [5]. Matthew McGrail and Belinda O’Sullivan
report data obtained from an annual national cross-sectional survey of doctors in
Australia conducted between 2008 and 2017. The survey revealed that GPs with fellowship
of a rural faculty, were more likely to use advanced skills, especially procedural
skills, compared with standard GPs. Membership in a rural faculty was also associated
with significantly improved geographic distribution. Thus, the rural faculties were
found to be critical in building and sustaining a general medical practice workforce
that is better able to respond to health needs in smaller, often isolated, communities.
The following paper takes us to research conducted on an innovative model of workers’
healthcare assistants by a group of Portuguese researchers in Brazil [6]. This study
presented and validated the Workers’ Healthcare Assistance Model (WHAM) which includes
an interdisciplinary approach to health risk management. The study was conducted between
2011 and 2018 in a workers’ occupational health center in the oil industry in Brazil.
The study of a sample of workers (n = 965) showed a sustainable return on investment,
covering workers with heart disease and diabetes. The study concludes that this model
of workers’ healthcare assistants is capable of enhancing workers’ health in companies,
while reducing costs for employers and improving workers’ quality of life within the
organisation.
Luis Miguel Dos Santos has investigated reasons behind the shortage of public health,
social work, and psychological counselling professionals who can provide multilingual
services to minority groups and foreign residents in South Korea [7]. This fascinating
study explored why graduates and professionals with multilingual skills in these three
professions decided to leave their professional fields for the hospitality and business
service sectors, particularly for those who completed their initial training at a
university outside Korea. Twelve professionals were interviewed in depth, based on
an approach consistent with social cognitive career theory. The results indicated
that public health, social work, and psychological counselling services-related positions
were not available, and that there was a lack of career development skills amongst
these graduates who were working in fields such as tourism (such as a social worker
working as a car valet) and marketing.
The next paper in this special issue investigated the future of careers for public-health
professionals with training in climate change based on analysis of 16 years’ worth
of job postings and a survey with prospective employers [8]. Heather Krasna and colleagues
from the Mailman School of Public Health at Columbia University in the USA conducted
this study in a context where skills and competencies relevant to climate change have
been incorporated into the curricula of schools of public health in Europe and Australia.
They discovered that current employers value knowledge of fields such as climate mitigation
and adaptation, climate-health justice, effects of climate on health, health impact
assessment, risk assessment, pollution-health consequences and causes, geographic
information system (GIS) mapping, communication, finance and economics, policy analysis,
systems thinking, and interdisciplinary understanding. The study found that the current
job market for public-health professionals with training in climate change appears
small and may grow in the next 5–10 years.
Innovative health workforce solutions were needed for the Swedish mental health workforce
due to the recent refugee crisis. Sandra Gupta and colleagues from Uppsala University
Sweden explored the experiences of mental health workers towards new training solutions
to effectively manage unaccompanied refugee minors [9]. They suggest that dealing
with suicidal ideation can be challenging and feelings of helplessness can occur.
They suggest that collaboration between agencies and key stakeholders as essential
when targeting refugee mental health in a stepped care model to assist the mental
health workforce.
The next paper from Sierras-Davo and colleagues based in Spain and Greece discusses
how you can transform the future healthcare workforce across Europe through improvement
science [10]. They evaluate the experience of European nursing students after an intensive
one-week summer programme conducted in 2019 at the University of Alicante in Spain.
Based on the findings from the study, values like compassion, respect, or empathy
were identified as key elements of care. Furthermore, promoting international students’
networking emerged as the key to creating a positive provision for change and the
generation of improvement initiatives. They suggest that building a healthcare improvement
science culture may provide future healthcare professionals with critical thinking
skills and the resources needed to improve their future work settings.
Yuki Ohara and colleagues based in Japan discuss an interesting paper on job attractiveness
and job satisfaction of dental hygienists based on the 2019 Japanese dental hygienists
survey [11]. Using a nationally representative data set of 7869 working dental hygienists,
they analyse seven items of job attractiveness, 14 items of job satisfaction, and
13 items of request to improve the working environment. They implement item response
theory and structural equation modelling (SEM) in the analysis. They identify that
dental hygienists preferred national qualifications more than income stability. The
SEM also showed that job satisfaction consisted of two factors, ‘value for work’ and
‘working environment’, as did job attractiveness, with ‘contribution’ and ‘assured
income’. Finally, they suggest that improving job satisfaction and work environments
could help to improve the employment rate of dental hygienists, which could positively
influence patient care.
A very interesting commentary is featured as the penultimate article, titled Broken
Promises to the People of Newark. Franklin et al [12] discuss the relationship between
organised medicine, state and local leaders, and the people of Newark. The authors
emphasise that among medical schools, Rutgers New Jersey Medical School’s commitment
to Newark is meaningfully unique. This social contract between the medical school
and the people of Newark is identified through the portrayal of historical events
which led to the establishment and development of the medical school.
We round out this special issue with a rapid review of contemporary techniques and
practices in oral health workforce modelling, conducted by a team of researchers from
England and Australia [13]. Workforce modelling is used to inform health workforce
planning through examination of the current and future supply of professionals against
the need and demands of a population. The rapid review included 23 studies from 15
different countries. The study identifies that dentists were the sole oral-health
workforce group modelled in 13 studies; only five studies included skill-mix (allied
dental personnel) considerations. Furthermore, the most common application of modelling
was a workforce to population ratio or a needs-based demand weighted variant. Nearly
all studies presented weaknesses in modelling process due to the limitations in data
sources and/or nonavailability of necessary data to inform oral health workforce planning.
Skill-mix considerations in planning models were also limited to horizontal integration
within the oral health professions. This timely study identifies that planning for
the future oral health workforce is heavily reliant on quality data being available
for supply, demand, and needs models. Integrated methodologies that expand skill-mix
considerations and account for uncertainty are essential for future planning exercises.