Clarifying workforce flexibility from a division of labor perspective: a mixed methods study of an emergency department team.

BACKGROUND: The need for greater flexibility is often used to justify reforms that redistribute tasks through the workforce. However, "flexibility" is never defined or empirically examined. This study explores the nature of flexibility in a team of emergency doctors, nurse practitioners (NPs), and registered nurses (RNs), with the aim of clarifying the concept of workforce flexibility. Taking a holistic perspective on the team's division of labor, it measures task distribution to establish the extent of multiskilling and role overlap, and explores the behaviors and organizational conditions that drive flexibly. METHODS: The explanatory sequential mixed methods study was set in the Fast Track area of a metropolitan emergency department (ED) in Sydney, Australia. In phase 1, an observational time study measured the tasks undertaken by each role (151 h), compared as a proportion of time (Kruskal Wallis, Mann-Whitney U), and frequency (Pearson chi-square). The time study was augmented with qualitative field notes. In phase 2, 19 semi-structured interviews sought to explain the phase 1 observations and were analyzed thematically. RESULTS: The roles were occupationally specialized: "Assessment and Diagnosis" tasks consumed the largest proportion of doctors' (51.1%) and NPs' (38.1%) time, and "Organization of Care" tasks for RNs (27.6%). However, all three roles were also multiskilled, which created an overlap in the tasks they performed. The team used this role overlap to work flexibly in response to patients' needs and adapt to changing demands. Flexibility was driven by the urgent and unpredictable workload in the ED and enabled by the stability provided by a core group of experienced doctors and nurses. CONCLUSION: Not every healthcare team requires the type of flexibility found in this study since that was shaped by patient needs and the specific organizational conditions of the ED. The roles, tasks, and teamwork that a team requires to "be flexible" (i.e., responsive and adaptable) are highly context dependent. Workforce flexibility therefore cannot be defined as a particular type of reform or role; rather, it should be understood as the capacity of a team to respond and adapt to patients' needs within its organizational context. The study's findings suggest that solutions for a more flexible workforce may lay in the organization of healthcare work.

Análisis del desempeño del equipo local de salud: una experiencia de construcción / Analysis of the performance of the local health team: a construction experience

Desde 1992 PASCAP ha venido generando y difundiendo en la Subregión la propuesta de Análisis del Desempeño del Equipo Local de Salud, la cual se fundamenta en la gestión colectiva del trabajo como fuente que genera y facilita transformaciones en la práctica de los servicios de salud, construyéndose así un proceso de autoanálisis colectivo de la calidad del trabajo y del trabajador de salud. Este tipo y calidad de gestión implica implementar cambios en la organización de los procesos de trabajo vigentes en la mayoría de los servicios de salud, tornar la modalidad individual del trabajo en verdaderos y funcionales equipos de trabajo. Es, en resumen, un replanteamiento del cómo se ha concebido y ejecutado el quehacer en salud. (AU)

Core data: human resources for health: stocks and flows ­ education ­ management Jamaica, 2009. Document Series on tracking regional goals for human resources for health: a shared commitment

The Jamaican database on human resources in health (HRH) is an important component of the Health Human Resources Information Data Sets in the Americas and derives from the objectives of the Toronto Call to Action and the five critical challenges and twenty regional goals to be achieved in the ensuing decade ending in 2015. The specific objective of this phase of the study is to assemble a comprehensive database on all HRH in Jamaica and establish a system for the efficient, continual updating of this database. A team of researchers at the Epidemiology Unit (ERU) of the Tropical Medicine Research Institute (TMRI) identified the main stakeholders in HRH management in Jamaica under the three main areas: Stocks and flows, Regulatory framework and management practices, Training. Contact has been made with stakeholders to obtain the data on all HRH, and six databases have been created to include aggregate and individual data under the three categories above. These datasets are being managed under currently acceptable standards of database management with the requisite confidentiality and security arrangements. Data collection has been limited by the scarcity of data in some cases, while in others the required data management systems allow for easily retrievable data. Data from the public sector has been more easily obtained and less data have been forthcoming from the private sector, forcing the research team to resort to innovative tools such as surveys of medicals reps (salespeople of pharmaceutical companies) and extract data from the "yellow pages" listings. Analysis of these data reveals shortages across the health workforce in general and more so in some specific professions and in some regions of the country. HRH density of doctors, nurses and midwives in the public sector is approximately 12.1/10,000 population, and falls to lower levels in the Southern Regional Health Authority (SRHA). Even the largest estimates of HRH calculated in this paper show a ratio of 22.8 per 10.000 level for the whole country, while the level set by the World Health Organization to achieve a minimum level of health care is 25 / 10,000. The distribution of doctors, nurses and dentists is least favourable to the SRHA. The data also shows that in addition to a severe shortage of dentists in the public sector, there is a significant shortage of rehabilitation specialists in speech and occupational therapy. There is a predominance of female professionals even in traditional masculine professions like medicine, where the research found an M/F relation of 1:1. The ageing of the population and the increased burden of chronic diseases, in particular strokes and heart disease, may make it mandatory that greater attention be paid to these HRH areas of specialty in comparison to other areas like public health inspectors, which were a priority focus in an earlier time. The data so far does not allow for the linkages to be made between training facilities and the needs of the population. With the absence of good data on the societal needs it will be difficult to conclude whether and how much these institutional capacities should be increased, and if not, alternate ways of satisfy those needs. The Ministry of Health and the International Consortium for HR Planning have begun a process to address this problem linking health needs with HRH forecasts. More data will be required to assess the role of regulatory agencies and government bodies like the Ministry of Education and the Ministry of Labour in the international recruitment. There is nevertheless the need that all databases of regulatory bodies be electronically maintained in a form, which is easily retrievable This paper argues for the necessity of a continuous effort in data collection to establish this baseline database and in the development of a Human Resources Observatory, as a system to achieve a sustainable database to inform decisions and guide policies in HRH for Jamaica and the Region. (AU)

Core Data ECC: Dominica, Grenada, Saint Lucia, Saint Vincent and the Grenadines - 2009

In its 2006 annual report, the World Health Organization (WHO) reported on Human Resources for Health (HRH) among its 192 member states. This report recognized widely varying data availability, with many non-OECD nations having limited access to information on their health workforce. National data were collected as part of this effort, using three approaches: WHO national surveys conducted through its regional and country offices, contacting various national administrative sources, or "compiled from a previous version of the WHO's Global database on the health workforce"1. Data from many Caribbean nations were collected using this third approach, which obtained very little detail, with information that had not been updated for a number of years. To improve this paucity of information, the Human Resources for Health Unit of the PanAmerican Health Organization (PAHO) has partnered with the Ministries of Health in the Eastern Caribbean (EC) to support the systematic collection and country-level analysis of HRH data as part of the Region's 10-year commitment to health workforce development. There are nine Eastern Caribbean nations involved in this data collection process which is proceeding in three work phases: phase 1 included Barbados and has been completed, phase 2 includes four Eastern Caribbean Countries (ECC): Dominica, Grenada, Saint Lucia, and Saint Vincent and the Grenadines and is the subject of this report. Phase 3 will include Antigua and Barbuda, Saint Kitts and Nevis, Monserrat, and the British Virgin Islands. In addition, this PAHO data collection programme has been extended to other countries in the Caribbean Region: Belize, Jamaica, and Trinidad & Tobago. It is expected that these data collection exercises will form the basis for a regional HRH database to follow trends in human resources for health through time. In turn, this resource can help to inform priorities and sustainable policies for enabling a healthcare workforce tailored to the needs of the individual countries and the Region as a whole. This report from the Barbados/ECC data collection team, presents data from four Eastern Caribbean (EC) countries: Dominica, Grenada, Saint Lucia, and Saint Vincent and the Grenadines. (AU)