Assessing the status of health
workforces in operational
environments
Participant guide
Table of Contents
The 5 factors of workforce Classification ................................................................................................ 3
Background ............................................................................................................................................. 3
Overview of the tool ............................................................................................................................... 4
Participant guidelines ............................................................................................................................. 5
Introduction ........................................................................................................................................ 5
The tasks ............................................................................................................................................. 5
Follow-up ............................................................................................................................................ 6
Factor definitions .................................................................................................................................... 7
Service need ........................................................................................................................................ 7
Public profile ....................................................................................................................................... 8
Supply.................................................................................................................................................. 9
Operational Flexibility ....................................................................................................................... 10
Operational Capacity ........................................................................................................................ 11
Scoring Matrix for Health Workforce Classification Framework .......................................................... 12
The 5 Domains of Workforce Classification
Service need: service
stability, model of care,
clinical processes
Operational Capacity:
R&R, lead in time,
specificity of skills
Operational Flexibility:
regulatory, education
& training,
qualification
Public profile: public
confidence,
political/policy context,
labour market
positioning
Supply: size and
distribution, gender,
ethnicty, age
Background
In order to write an effective collective employment negotiations bargaining strategy there is an
need to consider a number of intersecting elements such as fiscal constraints, current and future
service delivery need and workforce issues.
This workforce tool was developed in response to a need for an evidenced based approach to
assessing and categorising the level of need of workforce. It has been used to support the collective
DHB employment negotiations processes. It has formed the baseline data gathering for operational
information on specific workforces and has helped identify where further investigation into
particular workforce issues is required.
There were two key drivers to the creation of this tool. The first was a need to assess and classify
health workforces whilst taking cognisance of the wider contextual factors which impact on the
overall New Zealand health system. The second key driver was a desire to have an evidence-based
method for District Health Boards (DHBs) to review their workforces as part of developing a
bargaining strategy for collective employment agreements. Previous assessments of the health
workforce have been anecdotal and lacked a whole of systems approach, nor did they provide a
logical framework to enable a comparison of workforces. It is intended this tool will benefit the
wider health system by providing a framework for evidential discussion to occur.
Use of the tool relies on consensus achieved via focus group who agree on a workforce classification
and where required make suggestions for further investigation.
The tool is time dependent so only provides information at the particular point in time in which the
process is undertaken. There is however the ability to repeat the process at a later date in order to
review any changes or other such trends
Overview of the tool
This qualitative assessment tool has been specifically designed to identify workforce pressures that
may have an impact on the capacity to deliver services. Its key purpose is to identify areas of
operational pressure for the particular workforce being examined. It is recommended that this tool
be used along side other assessment tools in evaluating a workforce.
This workforce assessment tool is a qualitative process that uses 5 domains to guide a facilitated
focus group discussion on the identified workforce. The need to have a diverse group of both
operational and professional viewpoints is imperative as it allows view s to be challenged and strong
rationale to be given in order to reach the final categorisation.
The first step of the process is to identify the scope of the assessment to be performed. Generally
this is for an occupational group but it could also be further refined to look review a particular
speciality for region. Having defined the scope the next stage is to gather all readily available
background information/data on this workforce to help inform the individual workforce assessment
and the group discussion. This report will include relevant operational DHB information on the
workforce, regulatory workforce data and strategic workforce information gathered from Health
Workforce New Zealand
This information is shared with the focus group participants prior to the focus group so they are able
to participant in an informed discussion on each of the 5 domains. During the focus group the
facilitator keeps the group focused on discussing the rating, and why, for the workforce in each
factor. Having rated each factor the scores are totalled the workforce is assigned to one of four
classification based on the level of intervention required. This classification is indicative only and
provides a rationale for further investigation to occur.
Stable Occupation
WATCHING BRIEF
Transitional Occupation
SOME INTERVENTION RECOMMENDED
Transitional/ Occupation Under Pressure
INTERVENTION REQUIRED
Occupation Under Pressure
INTERVENTION IMPERATIVE
Participant guidelines
Introduction
Thank you for agreeing to be involved in this workforce assessment. Your participation in this
process will enable a robust assessment of the workforce which will then assist with the
development of an appropriate bargaining strategy that will support the workforce needs of this
group.
By now you should be aware of who is the facilitator for this assessment. It is their responsibility to
manage the process and facilitate the focus group discussion. They are your guide during this
process. Please do not hesitate to contact them if you have any questions.
You are one of a number of people who have been chosen to assess this workforce. Getting the right
people involved is critical to this qualitative process as its validity is dependant on the quality of the
discussion and group reaching consensus. In this process a group of experts (the focus group) use an
iterative process to come to a consensus of the classification for this workforce. Because of the
nature of this process is it essential that all participants take an active role in sharing their individual
ratings and the reasoning behind those ratings.
The tasks
1. Read this workbook and the initial data report on this workforce. If you are unsure about what
is expected or have some questions about the workforce please contact the facilitator.
2. Decide an individual rating of the workforce. You should have received a link to this survey
when you received a copy of this work book. Please take you time to complete this survey and
give full explanations for your rating. It is this information that will enable the whole group to
reach consensus during the focus group discussion. The results of the survey will be summarised
and returned to you to support your participation in the focus group
3. Attend the focus group meeting. This usually takes 60-90 minutes and is general held via
conference call. Most of the meeting will be spent on group discussion and agreeing a rating for
each factor that results in a final classification. Discussion will be based on the results of the
online survey and will begin with service need and works across the scoring matrix ending with
operational capacity.
During this process you are encouraged to participate full in the discussions to ensure that your
view is considered along with the views of the other participants. The facilitator will manage the
scoring in each dimension and summarise at the end of each round to ensure that a consensus is
reached on the rating for each dimension. The final score out of each of the 5 domains will add
up to a total overall score which in turn will determine which classification is reached.
The Facilitator will keep notes of the key discussion and the scoring and any additional issues
which have arisen from group discussion that require further investigation as part of any ER/IR
processes.
Follow-up
The week after the focus group meeting the facilitator will send you a summary of the findings
including the final score and rationale for final agreement. It is important that you raise any key
issues you do not agree with or think have been misrepresented, at this time.
The final report will contain an agreed workforce classification and the corresponding rationale. This
report will be made available to the DHBs and will also be used to develop the bargaining strategy
for that specific work group.
Factor definitions
Service need
This domain includes factors such as

Service stability including changes to service demand which may be driven by population or
purchasing changes.

Operational deployment and intensity of use. Is this a seven day 24 hour service or Monday to
Friday business hours (is this capacity)

Clinical processes/models of care influence on occupational requirements for example
nurse/doctor led
Process
Under each of the 5 boxes on the next few pages please circle which rating you feel is most suitable
for the workforce in discussion.
Please then log onto survey monkey with the log in details you have been given and write the
corresponding ratings in the boxes provided. This will allow the facilitator to have a first round of
data for testing within the focus group. It is fine to change your opinion within the focus group, as
the purpose of the discussion is for this type of objective critique.
Rating Description
Example
1
Current demand does not exceed supply
and service picture has no particular
issues.
Occasional instances of increased
demand but majority of time is stable.
Increasing demand impacting on supply.
2
3
4
Service is stable and there are no anticipated
major changes to service delivery or demand in
the short term
Some instances of demand pressure on service
but stable overall
Service demand progressively increasing
impacting on service level or peak demand
periods increasing
Service operating at full capacity, peaks in
service demand driving instability in service
delivery.
Demand exceeds supply.
Public profile
This domain includes factors such as

Public confidence: does the lack of a readily available workforce pose potential public
confidence issues if the service cannot be delivered as required?

Political /policy context: political mandate/drivers for particular workforces

Labour market positioning: relative strength in the labour market
Rating Description
1
No current issue of public confidence or
political/policy factors.
2
Some Public confidence issues/policy issues
appearing which may impact on the workforce
3
Public confidence/political context/policy
change is directly impacting on the workforce
4
Public/political confidence in services is being
actively impacted by absence of the
workforce/or disruption to availability
Please provide an explanation for your rating.
Example
Low public profile in that there are
relatively few instances where the
workforce would gain increased political
/ public interest
Occasional confidence issues which may
be emerging, but workforce is till
relatively low in regards to gaining
public or political attention i.e. clinical
perfusionists
Where a workforce is being impacted on
by political / public changes but also
where workforce is impacting on public
and political environment i.e. by way of
strike that impacts on service provision
i.e. MRTs
This is usually true for inherently
political workforces i.e. RMOs, SMOs,
Midwives, Medical Physicists. More
common in autonomous than delegated
workforce roles.
Supply
This domain includes factors such as

Community / population health requirements: Are there sufficient numbers of this
occupational grouping within the system (via education and immigration)? Inward and outward
flows balanced?

Distribution: is there a general distribution issue or a specific local/regional maldistribution?

Gender/ethnicity/age: Is an aging workforce an additional risk factor? For example, is there
adequate Maori and Pacific representation to meet needs of specific communities?
Rating Description
Example
1
2
Stable supply pattern
May be with particular specialities,
rather than entire workforce
Often related to geographic distribution
issues – must ask group are these pure
supply issues or a maldistribution issue
occurring?
Real issues with supply pipeline of
professional group i.e. we need to
import greater than 50% of entire
workforce - medical physicists an
example
3
4
No major distribution or supply issues
Some Distribution issues emerging and wider
issues with supply
Distribution and supply issues increasingly
impacting on wider system.
Issues with overall size of workforce available.
Significant distribution and or supply issues
currently occurring, problems with small size of
available workforce.
Please provide an explanation for your rating.
Operational Flexibility
This domain includes factors such as

Regulatory influences impact under HPCAA 2003: statutory impacts on workforce availability

Custom and practice: are the current barriers/ways of working, custom and practice as opposed
to actual legislative barriers?

Sixe of occupational grouping: small numbers tend to be an additional risk factor

Scope of practice: how enabling/limiting is the current scope in terms of flexibility?

Ability to substitute: can you readily or easily substitute workforce elements if required? If not,
does this pose an additional risk?

Qualifications - educational pathways: timeframes for gaining competent practitioners
(longer/post grad qualifications additional risk as longer lead in).
Rating Description
Example
1
No current workforce flexibility issues
2
Some sector requirements to begin looking at
alternative models of care and roles for this
workforce
Emerging requirements for more flexible
workforce options
No need or requirement for additional
flexibility required. Role is substitutable
if required.
Occasional requirements for increased
flexibility needed, some substitution is
able if needed.
There is a need for more flexibility –
substitution is able but may be very
difficult i.e. SMO’s can be substituted
for RMOs if absolutely needed.
No substitution for workforce is
available if required – i.e. the roles that
this workforce perform as so specific
that no other workforce can do them if
absolutely required
3
4
Requirements for flexible workforce options,
but very limited/no available substitute
workforce that can perform the critical
function of this workforce
Please provide an explanation for your rating.
Operational Capacity
This domain includes factors such as

Lead in time for recruitment: either internal supply or ability to recruit internationally
(particularly if majority of source is gained internationally)

Recruitment and retention: including public/private drag on supply

Specificity of skills /competency required: how specialised are the skills required to perform
the role?

Suitably skilled workforce specific service/clinical process: does the current workforce have
all the skills required?

Additional regulations that are impacting on professions ability to practice

Ability to provide the environment/context for this workforce: Can the sector provide the
appropriate environment/context for this workforce to perform to capacity
Rating Description
Example
1
No significant recruitment and retention issues
2
Some recruitment and retention issues are
occurring
3
Generalised recruitment and retention issues
for specialised skills. Operational environment
is affected by potential lack of this workforce
due to higher level of workforce specialisation
required
Significant recruitment and retention issues for
specialised skills. Issues exist with gaining
appropriately skilled individuals
Easy access to more of the workforce
when required
Slightly more difficult recruitment
processes / timeframes for gaining of
workforce
Skills more specialised and harder to
find specific skill set i.e. 6month – 1 year
for recruitment
4
Please provide an explanation for your rating.
Long and often difficult recruitment
processes for gaining sufficiently
qualified individuals i.e. 1-2 years for
recruitment
Scoring Matrix for Health Workforce Classification Framework
Rating
Service Need
Public Profile
Supply
Operational flexibility
Operational Capacity
1
Service is stable and there are
no anticipated major changes
to service delivery or demand
in the short term
Some instances of demand
pressure on service but stable
overall
No current issue of public
confidence or political/policy
factors.
No major distribution or
supply issues
No current workforce
flexibility issues
No significant recruitment and
retention issues
Some Public confidence
issues/policy issues appearing
which may impact on the
workforce
Public confidence/political
context/policy change is
directly impacting on the
workforce
Some Distribution issues
emerging and wider issues
with supply
Some Sector requirements to
begin looking at alternative
models of care and roles for
this workforce
Emerging requirements for
more flexible workforce
options
Some recruitment and
retention issues are occurring
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, problems with small
size of available workforce.
2
3
Service demand progressively
increasing impacting on
service level or peak demand
periods increasing
4
Service operating at full
capacity Peaks in service
demand driving instability in
service delivery.
Distribution and supply issues
increasingly impacting on
wider system.
Issues with overall size of
workforce available.
Requirements for flexible
workforce options, but very
limited/no available substitute
workforce that can perform
the critical function of this
workforce
Generalised recruitment and
retention issues for specialised
skills. Operational
environment is affected by
potential lack of this workforce
due to higher level of
workforce specialisation
required
Significant recruitment and
retention issues for specialised
skills. Issues exist with gaining
appropriately skilled
individuals
Score
Health Workforce Classification Table
5-8
9-13
14-17
18-20
Stable Occupation
WATCHING BRIEF
Transitional Occupation
SOME INTERVENTION RECOMMENDED
Transitional/ Occupation Under Pressure
INTERVENTION REQUIRED
Occupation Under Pressure
INTERVENTION IMPERATIVE
Aileone & Rimmer 2011