In this blog series, I've shared my predictions for the future direction of health care policy and highlighted the ways in which jurisdictions are reforming their health care systems to improve equity. In this final policy blog, I explore how different jurisdictions are addressing a universal crisis: health care worker shortages.
Since 2020, governments have enacted policies at the state/provincial or national level to address the systemic issues underpinning the current crisis: the absence of a long-term workforce plan, poor pay, undersupply of training and education programs, inadequate recruitment and retention campaigns, and failure to address the mental and emotional needs of the healthcare workforce.
These failures have long pushed workers into early retirement or roles in competing organizations (both in and out of industry)—a trend that became more prevalent, and more urgent, during the pandemic. Despite newfound support from governments, organizational leaders still need to double down on long-term strategies that support staff's physical and emotional well-being within their institutions to maximize the impact of these policy interventions.
Below are four ways governments are intervening to address the workforce crisis in their jurisdictions—and what each means for organizations that operate in those contexts. These policy approaches are listed in order of shortest- to longest-term impact.
Some governments are offering monetary incentives for workers to stay in their current roles. In Australia, the federal government is offering up to $800AUD in retention payments for home and residential care workers staffed in public sites or who are employed through a staffing agency.
In Canada, the provincial government of Ontario offered all front-line nurses—including hospital, long-term care, retirement home, home care, mental health, and emergency services nurses—up to $5,000 each in retention pay. Employers will provide lump-sum payments to their full-time nurses and prorated payments for part-time or casual workers.
Our take: Turnover is a function of organizational culture, more so than money
This approach is intended to prevent turnover in the short-term. However, this will obviously not be enough to keep staff around in the long-term. Moreover, the results from our 2022 clinician survey show that burnout and not feeling valued are the top two contributors to turnover—ranking higher than competitive offers.
Organizations benefitting from this temporary funding boost should increase salaries to remain competitive. But more importantly, they should invest in long-term retention strategies that focus on meeting the evolving needs of employees—this can include a range of tactics, from creating wellness programs to providing options for heightened flexibility.
Jurisdictions in Australia and the U.K. are expanding their search for talent—especially nursing talent—beyond their borders.
The U.K. relaxed immigration rules and made more one-year visas available for home care workers to address the chronic workforce shortages in the sector. In Australia, the state government of Victoria is offering travel and relocation allowances of up to $13K AUD for foreign-trained medical staff. These payments represent a six-fold increase in incentives for international recruits.
However, lowering immigration barriers only solves part of the problem. The bigger challenge with recruiting talent from overseas is licensing and accreditation, which is not standardized across borders. Standards for clinical practice are determined by clinical associations and unions and may vary even within countries.
For example, a registered nurse in India may only be allowed to work as an enrolled nurse in the U.K. This ultimately compromises top-of-license care because staff are not allowed to perform the tasks that they would otherwise be able to in their home country.
Our take: Organizations must work to facilitate top-of-license practice for international recruits
Clinicians' inability to practice at the top of their license presents a significant operational and engagement challenge that leads to high turnover rates among international recruits. In the short-term, organizations can mitigate these challenges by standing up transition-to-practice programs that pair foreign-trained staff with preceptors that are aware of differences in education and training and scopes of practice. Additionally, being aware of clinicians' individual resumes will prevent leaders from staffing international recruits in suboptimal roles that keep them practicing below their license.
In the long run, organizations may also look to create training programs in the countries from which they are recruiting, to enable a seamless transition to practice. And lastly, organizations should work with unions and associations to standardize clinical standards to ensure that titles and accreditations are transferrable.
Some efforts to build a pipeline of new graduates specifically target services or regions in which shortages are most pronounced. For instance, the Belgian government implemented a "sub-quota system" that limits the number of students allowed to practice certain medical specialties, such as surgery and gynecology. The goal of this policy is to funnel more students into general practice.
To a similar end, the South Korean government introduced new financial incentives for medical students entering "less lucrative" specialties, such as epidemiology, or geographic areas that face chronic workforce shortages.
Other jurisdictions, however, are seeking to expand the pipeline of clinicians more broadly. In Ontario, Canada, for example, the provincial government increased the number of spots available in medical schools and residency programs across the next the five years to expand the pipeline of new doctors entering the workforce, regardless of specialty.
Our take: Governments' push to expand the pipeline of new graduates entering the workforce will only benefit organizations that invest in retaining, and fully leveraging the expertise of, their experienced staff
These efforts aim to address health care worker shortages in the long-term. However, organizations in jurisdictions whose governments are pursuing similar approaches still must invest in retaining their current workers to ensure that new graduates have the support and mentorship they need from their more experienced colleagues.
As retirement-age workers leave the workforce and are replaced by these new graduates, organizations will face a shortage of experience and expertise. Organizations must act now to implement sustainable care models that fully utilize the expertise of their experienced staff in order to facilitate this transition into a future where the workforce is comprised mostly of novice staff.
The most ambitious policies are those seeking to change how and how much workers are paid and make meaningful improvements to workers' material conditions. We see examples of both in two provinces in Canada.
First, the provincial government of British Columbia is changing how family physicians bill the government—a move that will lead to up to a $135,000CAD income increase for a typical doctor. Under the new plan, doctors' income will increase depending on how much time they spend with a patient, how many patients the doctor sees each day, patient complexity, and the number of patients in the practice—a shift away from the fee-for-service model common in other provinces.
And in Quebec, the provincial government revealed a three-year plan to reform its health care and social services system, with a focus on improving working conditions for nurses. The measures included in the campaign are eliminating mandatory overtime for nurses, hiring more administrative staff to take over non-clinical work, and launching a massive recruitment campaign.
Our take: Government intervention can only go so far without action from organizational leaders to implement reforms within their own institutions
The conditions that have created the current workforce crisis are a consequence of underinvestment and poor workforce planning at the national level. Governments are attempting—albeit arguably too late—to halt and reverse the exodus workers by investing in retention and building pipeline of new entrants.
Despite this surge of investment and interest from political leaders, the onus remains on individual organizations to ensure that they address problems in their work environments. This requires leaders need to invest in long-term strategies to support their employees both in, and out, of the workplace.
Workforce burnout is a long-standing challenge for hospitals and health systems. But when Covid-19 emerged, the challenge magnified as the health care workforce simultaneously managed their own health concerns, added work, and emotional stress presented by the pandemic. Health care leaders are now seeing a workforce that is increasingly burned out and leaving their roles at an unprecedented rate.
Leaders must invest in the space and support for their workforce to recover from their experiences across the pandemic. If staff are not able to restore a sense of physical and emotional wellbeing, health care organizations should brace for continued turnover and a long-term burnout challenge.
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