Making innovation work

“Change will not come if we wait for some other person or some other time. We are the ones we’ve been waiting for. We are the change that we seek.”

— Obama (Inauguration Speech).

How can we overcome barriers and introduce the innovation needed to remedy shortages and to reform the health workforce?

Role substitution

Health workforce innovation, as we have learned may require role substitution, new health worker roles, approaches to working and models of care. What is clear is that a flexible and adaptable workforce is essential to provide health services for the future. Change can be difficult to implement and sustain in healthcare organisations.

Enablers to innovation

So what are the enablers to innovation? The literature has documented that organisational climate, leadership engagement and resources are important. Six building blocks of an innovative culture have been defined by Rao and Weintraub (2013) as:

• values
• behaviours
• climate
• resources
• processes
• success

Implementation and diffusion

Innovation implementation and diffusion is complex in health. Greenhalgh and her colleagues in a major text published in 2005 provided an overview from a systematic review conducted on the diffusion, spread and sustainability of innovation in health service organisations. This significant work analysed innovation in health service organisations and provided a conceptual model for understanding innovation diffusion (Greenhalgh et al., 2005).

Other authors describe leadership, managerial levers and business processes as the determinants of innovation and impediments to innovation being conflict, lack of infrastructure, and external disruption. In a systematic review of the literature, professionalism, organisational structure, strategy, organisational learning, positive climate and financial resources have been identified as the determinants for innovation.(Crossan & Apaydin, 2010)

Innovations based on evidence

Health workforce innovations can be tested and should always be based on strong empirical evidence. To introduce health workforce innovations, new policy, changes to legislation, registration processes and leadership maybe necessary to successfully drive reform. Leaders must work through these requirements despite the complexity. What is clear is that to deliver targeted, efficient and quality care, the workforce of the future will need to be responsive to the needs of individual patients at different points in time and across progressive stages of life (Lipstein and Kellerman 2016).

Innovation fundamentals

Innovation in health workforce to future-proof against health challenges such as rising healthcare expenditures, a growing burden of chronic disease, ageing populations and workforce to name a few should be based on solid planning fundamentals. These can be summarised as :

• goals and objectives for the health system and timeframes (short, medium and longer term)
• understanding of the current situation and future outlook for health and the health workforce
• use of scenario analysis and data collection, forecasting and analysis using quantitative and qualitative methods
• linkage to policy actions and funding priorities
• stakeholder involvement and engagement at all steps

The role of health service leaders in enabling innovation in workforce planning is critical. They can drive the implementation of workforce policies that focus away from staff-mix (numbers) to the skill-mix (roles, functions, responsibilities, tasks) that are needed to deliver health services for the future.

Changing skill-mix is a policy reform that can increase productivity of the healthcare system, address workforce shortages so that the right services can be delivered at the right time in the right place.

Your Task

Reflect on whether role substitution can provide rural health services and improve access to timely health care services. Can you think of other examples of roles substitutions? Share your ideas with the others in the course.

References

Crossan, M. M., & Apaydin, M. (2010). A multi-dimensional framework of organizational innovation: A systematic review of the literature. Journal of Management Studies, 47(6), 1154–1191. Retrieved from: http://doi.org/10.1111/j.1467-6486.2009.00880.x

Greenhalgh, et al. (2005). Diffusion of innovations in health service organisations: a systematic literature review, BMJ, June, Blackwell.

Lipsten, S.H.& Kellermann, A, L. (2016). Workforce for 21st-Century Health and Health Care, JAMA, 316(6)

The Joint Action on Health Workforce Planning and Forecasting: Results of a European programme to improve health workforce Policies. Retrieved from: http://portal.healthworkforce.eu/

George, A.S., Campbell, J., Ghaffar, A. (2018). Advancing the science behind human resources for health: highlights from the Health Policy and Systems Research Reader on Human Resources for Health and HPSR HRH reader collaborators, Health Research Policy and Systems, 2018, 16(80).

Gauld, R. (2018). Disrupting the present to build a stronger health workforce for the future: a three-point agenda, Journal of Primary Health Care, 10(1): 6-10. Retrieved from: https://doi.org/10.1071/HC17083