The challenges of a globally mobile health workforce

So I think around sustainability there’s two constructs to consider at first. The first is sustainability, our ability to maintain a certain level of workforce, a certain degree of ratio of workforce numbers to population and community. So at first, we’re working on developing what is an acceptable level of staff ratio, workforce ratio to population. In many countries around the world, in many regions around the world, in many parts of countries around the world, the workforce connectivity ratio to population is not high enough to ensure that we’ve got adequate access, adequate agility to actually respond to the need. The second part of the issue around sustainability is over time, our ability to maintain that level.

In many parts of the world, experience has shown us that if we encourage new students to become graduates in health services from rural, remote, and geographically difficult situations, there is a high degree of chance that they’ll return to those areas to live and to practise on an ongoing basis. So issues of professional autonomy, being a sole individual, small number of practitioners in workforce, impact on flow, issues on peer connectivity to refer to other colleagues in the health workforce team, to consult with other colleagues, ongoing education and learning and that kind of isolation become quite important.

The World Health Organisation currently is projecting that across the next eight years, 40% of the world’s nursing workforce will be retiring. So an ageing population is impacted inside the workforce itself. And features of health workforce are it takes a long time to train and give experience to health workers. And so it’s not a simple matter of just number replacement if people leave the workforce through retirement, through career changes because to bring other health professionals into the delivery frame takes a number of years. The second impact is role extension and role changes for health workforce and health professionals is affected by the ageing population. So the actual clinical presentation or social presentation for an ageing population is different.

Managers of health workforce planning need to have the necessary skills to actually undertake what is quite a specialised task, need to ensure they have the right information. Some information is easily gatherable in terms of numbers and counts of professional groups, but other information is hard to get to understand about the workforce. And I would differentiate that from leadership in health workforce. Leaders have a responsibility and an opportunity to articulate what is a direction or a vision, or what are the goals that we need to achieve in health workforce delivery and to facilitate system change, people thinking, acceptance arrangements, reform to actually achieve those workforce goals.

So there’s a real dichotomy of responsibility around this notion of leadership and management in health workforce planning.

Clinical leadership involving professional clinicians in decision making is an important future step and an important construct for the future of health services generally, and particularly around this area of health workforce planning. And I think the important thing is the word leadership. We are inviting clinicians who have a role and responsibility in delivery of care now within organisations, teams, groups, and professional groups, and we’re inviting them to bring knowledge, understanding of what actually happens in delivering care to the community, to those decision making processes, to those planning processes, to those future development processes. So we very much need to involve clinicians in the leadership aspect rather than the administrative or management aspect.

And so we need to achieve this balance between clinicians in clinical practise and clinicians and clinical leadership. That I think is a critical aspect of it. And yes, clinical leaders very much are about deciding on future models of care, on how we go about delivering health services, future training and learning approaches and requirements, future and emerging health status issues within a population.