Providing Operational Advice Process into ER Negotiations May 2012 Commenced 2009 Informing BSG development Lack of current tools available to DHBs to critically evaluate the relationship between health workforces and the operation of wider systems services ID: 359546
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Slide1
Workforce Prioritisation Tool
Providing Operational Advice Process into ER Negotiations
May 2012Slide2
Commenced 2009Informing BSG development
Lack of current tools available to DHBs to critically evaluate the relationship between health workforces and the operation of wider systems / services
FW informants, A,T&S Strategy Group, prioritisation for 44+ workforces Action research approach to development Rationale: consistency, standardised, endorsed, adaptable approachIterative development
Background Slide3
The need for more suitable frameworks for health workforce monitoring and development not newPrevious assessments have not taken a ‘whole of systems approach' nor provide a logical framework as to how workforces can be compared to each other or within a broader systems perspective
Ability to assess and classify health workforces whilst taking cognisance of the wider contextual factors which impact on the overall New Zealand health system
Move from anecdotal to more evidential viewProvision of evidence to make better informed ER and IR decisions, specifically with MECA agreements
Framework Requirements Slide4
Identify areas of operational pressure where intervention may be requiredUse across multiple areas, service settings or with specific occupational group
Reliant on consensus achieved via focus group and cross section of expertise
Provision of rationale for further investigation to occur; Macro-MicroTool is time dependent - however has ability to repeat the process at a later date in order to review any changes or other such trends
Requirement:
Screening Tool Design Slide5
Purpose to develop and validate a framework to allow classification of health workforces according to their current status within the New Zealand health system
Allows workforces to be examined from a system perspective as to whether they are stable or under pressure, offers potential to tailor funding to match the classification
Study further developed FW, in depth interviews DHBNZ, pilot testing, Delphi process over 3 months. Research Component Slide6
Delphi Method, iterative process used to accumulate/refine anonymous opinions of experts using data collection and analysis techniques combined with feedback (Skulmoski, Hartman & Krahn
, 2007).
Well suited method when there is incomplete knowledge about a problemInterviews – DHBNZ 2011Prototype – pilot testing Delphi – 3 round testing
Methodology Slide7
Five Domains Slide8
Service Needs
Public Profile
Supply
Operational Flexibility
Operational Capacity
1
Service stable and no anticipated major changes to service demand in the short-term.
No current issues of public confidence or political/policy factors.
No major distribution or supply issues.
No current requirement for workforce flexibility for this occupational group. Some workforce substitution available.
No recruitment and retention issues.
2
Some instances of demand pressure on services but stable overall.
Some public confidence issues /policy issues appearing which may impact on the workforce.
Some distribution and /or supply issues emerging and wider issues with supply. Emerging requirement to begin looking at innovation and role changes for this workforce and/or related workforce (substitution options). Some recruitment and retention issues are occurring. 3Service demand progressively increasing, impacting on overall service level or peak demand periods increasing. Public confidence /political context /policy change is directly impacting on the workforce.Distribution and/or supply issues increasingly impacting on wider system. Issues with overall size of workforce available.There is a requirement for more flexible workforce options. Some substitution and/or workplace innovation reducing current pressures Generalised recruitment and retention issues. Operational environment is affected by gaps in this workforce due to the specialised skills they have 4Service operating at full capacity. Peaks in service demand driving instability in demand environment. Public /political confidence in services is being actively impacted by absence of the workforce / or disruption to availability.Significant distribution and or supply issues currently occurring. Overall available workforce supply is considered below replacement needs. Requirement for flexible workforce options, but very limited/ no available substitute workforce that can perform the critical functions of this workforce. Significant recruitment and retention issues . Scarcity of workforce is compromising operational environment.
Scoring Matrix Slide9
Overall Scoring
5-8
Stable Occupation:
WATCHING BRIEF
9-13
Transitional Occupation:
SOME INTERVENTION RECOMMENDED
14-17
Transitional/ Occupation Under Pressure:
INTEVENTION REQUIRED
18- 20Occupation Under Pressure: INTERVENTION IMPERATIVE Classification Slide10
Identify scope of the assessment to be performed - usually assessing a workforce as a whole but consideration can include particular domains that are relevant to the workforce(s) being discussed:
Whole of workforce
: general consideration of a specific workforce e.g. nursing, midwifery Professional Groupings: specific practice areas relevant to a particular work group Specialities and sub-specialties
: e.g. nursing such as medical, surgical, ED, Critical Care, operating theatre etc
Geographic
: rural /urban; across regions
Service /deployment based
: medical, surgical, mental health etc
Patient categories
: hi / low dependency
Required Steps:
1. Identify scope of assessmentSlide11
Agree facilitatorLead focus group discussion and facilitate the process (selection, invitation of participants, scheduling , sending required info)
Write up of the focus group and overall findings – operational advice piece
Carry out any follow up investigation that is identified from conducting of the focus group. 2. Focus Group FacilitationSlide12
Establish a focus group
Sector health expertsMultidisciplinary if possible, include adequate representation from the workforce being discussedApproximately 10-20 participants in the focus group in totalShould include other professional, organisational and operational representation to ensure all perspectives can be considered Have a variety of geographical representation if conducting a national assessment of a particular workforce.
3. Focus Group SelectionSlide13
Gather all available background information /data on workforce to help inform group discussion and ensure adequate preparation Data should include relevant operational DHB, regulatory and strategic workforce information from Health Workforce New Zealand
Data template.
4. Background information relevant data on the workforce Slide14
Can be conducted either face to face or by teleconference. Teleconference is a preferred method and can facilitate the assessment tool process wellApproximately 60-90 minutes should be sufficient to conduct the process.
5. Conduct the focus groupSlide15
The 5 domains Workforce classification – provide an overview of the four potential outcomes of scoring; stable , transitional, transitional /
underpressure
, underpressureScoring matrix
6. Overview of Process & Booklet Slide16
Reconfirm final classification reachedReiterate any additional issues which have arisen from group discussion that require further investigation as part of any ER/IR processes
Classification then provides a basis from which other discussions can be generated and also helps to provide direction on what areas are causing pressure or particular issues to workforce being reviewed.
7. Meeting CompletionSlide17
Proposed Process
Operational Advice Process
Gather Information Confirm Themes Refine Themes Agree
Semi-structured Test
Test
Preliminary
Conversation using Endorsement
assessment tool
Focus group members Focus Group Focus Group
Employed workforce data and analysis / existing information, reports Bargaining
Strategy Group Slide18
Use of screening tool only one process
Forms baseline data, helps generate further investigation into particular workforce issues as warranted
Should never be used as an all encompassing definition / tool, but as a gauge or pointer for further work to occurAttention should be given to ensure data gathering and other forms of workforce review are undertakenUsed a best proxy to link wide sector views, underpinned by operational evidence and HR data sources.
DisclaimerSlide19
Where should information (both operational and strategic) currently come from?
Focus group representation – who should be on the groups?
What other data could/should be collected?Group Session: Key Questions Slide20
What worked, what didn’t?Information gathering conclusions
Focus group suggestions
Feedback Slide21
Build this into highly interactive tool and place online so that DHBs can use at the macro and possibly micro level as an input to carry out their workforce planning and not just limit to a feed into the employment relations and bargaining (panellist 15).
The real strength of this tool would be to scope all parts of the workforce and then use the appropriate part during bargaining (panellist 2)
Research Findings: Future Use Slide22
Need to identify a further part of the tool that serves to measure the “value” added by a workforce to the health system. It must link to an efficiency/productivity base so that we can demonstrate true value (panellist 7).
Beneficial to establish a tripartite work group of representatives of (say) employers, unions and central government to achieve a common view of pressure points and priorities. This should be supported by an analytical unit and, if warranted, sub-work groups that would be focussed on specific workforces or perceived problematic areas (panellist 14).
A system that makes prioritisation transparent is important, although still vulnerable to political will. The above would assist in reflecting a bargaining strategy environment where trade-offs are made in the light of both quantitative measurement but supported also by qualitative feedback. An example of this would be the value of “MRTs” as a collective grouping in the provision of diagnostic services versus the patient journey around say cancer treatment (panellist 5).
Future Use Continued Slide23
One thing that would significantly increase the value of this type of prioritisation framework in an ER/IR context would be to apply the framework to all health sector workforces at the same time, at a point identified as the ‘beginning’ of the bargaining round (accepting that the cyclical nature of bargaining could make the identification of a beginning somewhat arbitrary)...would mean that when the health sector is considering where to best invest the limited additional funding available, this would be informed by operational and strategic workforce imperatives across the sector and could be targeted accordingly (panellist 11).
At present, with the framework being applied to specific workforce groups as their collective agreements come up for renewal, there is not an overarching sector-wide view of the various workforce priorities against each other (panellist 10).
A standard tool such as this will ensure consistent measurement across and between workforces and should enable prioritisation and planning based on risk, and anticipated change (panellist 8).
Future Use continued Slide24
Links to productivity measures as a means of comparison of workforces was also suggested
Feedback re the need to combine both quantitative and qualitative measurement in any approach to workforce prioritisation in the ER/IR context and to ensure that one measurement was not prioritised above another
Further Research Slide25
Tool be further developed and undergo wider sector testing. Could allow sector embedding and engagement as well as build on current findings
The framework be used with all MECA renewals. Use as a standardised tool as it could ensure consistent measurement across and between workforces and could enable prioritisation and planning based on risk and anticipated change
Could be applied to all health sector workforces at the same time, therefore allowing identification at the beginning of the bargaining round.
Recommendations