The impact of COVID-19 on the mental health and substance use health (MHSUH) workforce in Canada: a mixed methods study.

BACKGROUND: The increased need for mental health and substance use health (MHSUH) services during the COVID-19 pandemic underscores the need to better understand workforce capacity. This study aimed to examine the pandemic's impact on the capacity of MHSUH service providers and to understand reasons contributing to changes in availability or ability to provide services. METHODS: We conducted a mixed method study including a pan-Canadian survey of 2177 providers of MHSUH services and semi-structured interviews with 13 key informants. Survey participants answered questions about how the pandemic had changed their capacity to provide services, reasons for changes in capacity, and how their practice had during the pandemic. Thematic analysis of key informant interviews was conducted to gain a deeper understanding of the impact of the pandemic on the MHSUH workforce. RESULTS: Analyses of the survey data indicated that the pandemic has had diverse effects on the capacity of MHSUH workers to provide services: 43% indicated decreased, 24% indicated no change, and 33% indicated increased capacity. Logistic regression analyses showed that privately funded participants had 3.2 times greater odds of increased capacity (B = 1.17, p < 0.001), and participants receiving funding from a mix of public and private sources had 2.4 times greater odds of increased capacity (B = 0.88, p < 0.001) compared to publicly funded participants. Top reasons for decreases included lockdown measures and clients lacking access or comfort with virtual care. Top reasons for increases included using virtual care and more people having problems relevant to the participant's skills. Three themes were constructed from thematic analysis of key informant interviews: the differential impact of public health measures, long-term effects of pandemic work conditions, and critical gaps in MHSUH workforce data. CONCLUSIONS: The COVID-19 pandemic has had a substantial impact on the capacity of the MHSUH workforce to provide services. Findings indicate the importance of increasing and harmonizing funding for MHSUH services across the public and private sectors, developing standardized datasets describing the MHSUH workforce, and prioritizing equity across the spectrum of MHSUH services.

Out from the shadows: What health leaders should do to advance the mental health and substance use health workforce.

The Mental Health and Substance Use Health (MHSUH) impacts of the COVID-19 pandemic are proving to be significant, complex, and long-lasting. The MHSUH workforce-including psychologists, social workers, psychotherapists, addiction counsellors, and peer support workers as well as psychiatrists, family physicians, and nurses-is the backbone of the response. As health leaders consider how to address long-standing and emerging health workforce challenges, there is an opportunity to move the MHSUH workforce out from the shadows through full inclusion in health workforce planning in Canada. After first examining the roots and consequences of the long-standing exclusion of the MHSUH workforce, this paper presents findings from a recent study showing how the pandemic has compounded MHSUH workforce capacity issues. Priorities for MHSUH workforce action by health leaders include closing regulation gaps, engaging the public and private sectors in coordinated planning, and accelerating data collection through a central health workforce registry.

Implementing leading practices in regional-level primary care workforce planning: Lessons learned in Toronto.

Investment in capacity for implementation of leading practices in regional-level health workforce planning is essential to support equitable distribution of resources and deployment of a health workforce that can meet local needs. Ontario Health Toronto and the Canadian Health Workforce Network (CHWN) co-developed and operationalized an integrated workforce planning process to support evidence-based primary care workforce decision-making for the Toronto region. The resultant planning toolkit incorporates planning processes centred around engagement with stakeholders, including environmental scanning tools and a quantitative planning model. The outputs of the planning process include estimates of population need and workforce capacity and address challenges specific to Toronto, such as patient mobility, anticipated rapid population growth, and physician retirement. We highlight important challenges and key considerations in the development and operationalization of workforce planning processes, particularly at the regional level.

Enhancing the capacity of the mental health and substance use health workforce to meet population needs: insights from a facilitated virtual policy dialogue.

BACKGROUND: Timely knowledge mobilization has become increasingly critical during the COVID-19 pandemic and complicated by the need to establish or maintain lines of communication between researchers and decision-makers virtually. Our recent pan-Canadian research study on the mental health and substance use health (MHSUH) workforce during the pandemic identified key policy barriers impacting this essential workforce. To bridge the evidence-policy gap in addressing these barriers, we held a facilitated virtual policy dialogue. This paper discusses the insights generated at this virtual policy dialogue and highlights how this integrated knowledge mobilization strategy can help drive evidence-based policy in an increasingly digital world. METHODS: We held a 3-hour virtual policy dialogue with 46 stakeholders and policy decision-makers as the final phase in our year-long mixed-methods research study. The event was part of our integrated knowledge mobilization strategy and was designed to generate stakeholder-driven policy implications and priority actions based on our research findings. The data collected from the virtual policy dialogue included transcripts from the small-group breakout rooms and main sessions, reflective field notes and the final report from the external facilitator. Coded data were thematically analysed to inform our understanding of the prioritization of the policy implications and action items. RESULTS: Facilitated virtual policy dialogues generate rich qualitative insights that guide community-informed knowledge mobilization strategies and promote evidence-informed policy. Our policy dialogue identified actionable policy recommendations with equity as a cross-cutting theme. Adapting policy dialogues to virtual formats and including technology-assisted facilitation can offer advantages for equitable stakeholder participation, allow for deeper analysis and help build consensus regarding evidence-based policy priorities. CONCLUSIONS: Our facilitated virtual policy dialogue was a key knowledge mobilization strategy for our research on the capacity of the Canadian MHSUH workforce to respond to the COVID-19 pandemic. Our policy dialogue allowed us to engage a diverse group of MHSUH workforce stakeholders in a meaningful action-oriented way, provided an avenue to get feedback on our research findings, and generated prioritized action items that incorporated the knowledge and experience of these MHSUH workforce stakeholders.

Co-developing an integrated primary care workforce planning approach at a regional level: overarching framework and guiding principles.

Health workforce planning provides a crucial evidence-base for decision-makers in the development and deployment of a fit-for-purpose workforce. Although less common, health workforce planning at the regional level helps to ground planning in the unique realities of local health systems. This commentary provides an overview of the process by which an integrated primary healthcare workforce planning toolkit was co-developed by university-based researchers with the Canadian Health Workforce Network and partners within a major urban regional health authority. The co-development process was guided by a conceptual framework emphasizing the key principles of sound health workforce planning: that it (1) be informed by evidence both quantitative and qualitative in nature; (2) be driven by population health needs and achieve population, worker and system outcomes; (3) recognize that deployment is geographically based and interprofessionally bound within a complex adaptive system; and (4) be embedded in a cyclical process of aligning evolving population health needs and workforce capacity.

An integrated primary care workforce planning toolkit at the regional level (part 1): qualitative tools compiled for decision-makers in Toronto, Canada.

BACKGROUND: A regional health authority in Toronto, Canada, identified health workforce planning as an essential input to the implementation of their comprehensive Primary Care Strategy. The goal of this project was to develop an evidence-informed toolkit for integrated, multi-professional, needs-based primary care workforce planning for the region. This article presents the qualitative workforce planning processes included in the toolkit. METHODS: To inform the workforce planning process, we undertook a targeted review of the health workforce planning literature and an assessment of existing planning models. We assessed models based on their alignment with the core needs and key challenges of the health authority: multi-professional, population needs-based, accommodating short-term planning horizons and multiple planning scales, and addressing key challenges including population mobility and changing provider practice patterns. We also assessed the strength of evidence surrounding the models' performance and acceptability. RESULTS: We developed a fit-for-purpose health workforce planning toolkit, integrating elements from existing models and embedding key features that address the region's specific planning needs and objectives. The toolkit outlines qualitative workforce planning processes, including scenario generation tools that provide opportunities for patient and provider engagement. Tools include STEEPLED Analysis, SWOT Analysis, an adaptation of Porter's Five Forces Framework, and Causal Loop Diagrams. These planning processes enable the selection of policy interventions that are robust to uncertainty and that are appropriate and acceptable at the regional level. CONCLUSIONS: The qualitative inputs that inform health workforce planning processes are often overlooked, but they represent an essential part of an evidence-informed toolkit to support integrated, multi-professional, needs-based primary care workforce planning.

An integrated primary care workforce planning toolkit at the regional level (part 2): quantitative tools compiled for decision-makers in Toronto, Canada.

BACKGROUND: Health workforce planning capability at a regional level is increasingly necessary to ensure that the healthcare needs of defined local populations can be met by the health workforce. In 2016, a regional health authority in Toronto, Canada, identified a need for more robust health workforce planning infrastructure and processes. The goal of this project was to develop an evidence-informed toolkit for integrated, multi-professional, needs-based primary care workforce planning for the region. This article presents the quantitative component of the workforce planning toolkit and describes the process followed to develop this tool. METHODS: We conducted an environmental scan to identify datasets addressing population health need and profession-specific health workforce supply that could contribute to quantitative health workforce modelling. We assessed these sources of data for comprehensiveness, quality, and availability. We also developed a quantitative health workforce planning model to assess the alignment of regional service requirements with the service capacity of the workforce. RESULTS: The quantitative model developed as part of the toolkit includes components relating to both population health need and health workforce supply. Different modules were developed to capture the information and address local issues impacting delivery and planning of primary care health services in Toronto. CONCLUSIONS: A quantitative health workforce planning model is a necessary component of any health workforce planning toolkit. In combination with qualitative tools, it supports integrated, multi-professional, needs-based primary care workforce planning. This type of planning presents an opportunity to address inequities in access and outcome for regional populations.

Harnessing instability as an opportunity for health system strengthening: A review of health system resilience.

In recent years, resilience has emerged as a prominent topic in global health systems discourse as a result of the increasing variety and volume of sources of instability inflicting strain on systems. In line with this study's intent to bring together existing literature on health system resilience as a means to understand the process through which systems achieve resilience, a review of academic literature related to health system resilience was conducted. Emerging from this review is an operational model of resilience that builds on existing health systems frameworks. The model highlights health system resilience as a process through which leaders in all sectors need to be mobilized in order to harness instability as an opportunity for health system strengthening rather than a threat to the system's sustainability and integrity.

The Network of Scholars Strategy: A Case Study of Embedded Research Activities in Nova Scotia to Advance Health System Impact and Outcomes.

The Canadian Institutes of Health Research - Institute of Health Services and Policy Research's (IHSPR's) Strategic Plan 2021-2026 for accelerating health system transformation is well positioned to meet the strategic priorities being outlined by many health systems in Canada and internationally (CIHR IHSPR 2021). The IHSPR Health System Impact Fellow program has been a strong influence on the embedded research and scientist program in Nova Scotia, namely, the Network of Scholars Program, which was implemented just before the pandemic. The network includes scientists and scholars from diverse academic backgrounds and skill levels including alumni of the Health System Impact Fellow program. The Network of Scholars has over 30 scholars and approximately 100 academic partners and scientists supporting embedded activities such as rapid reviews, implementation science and rapid evaluation initiatives. These embedded activities are front facing to the needs and priorities of the health system. This commentary highlights the importance of IHSPR's outlined strategic plan and direction, which are consistent with the experience and the needs for embedded supports within the Nova Scotia health system.