Assessing the status of health workforces in operational environments Facilitator guide Table of Contents The 5 Domains of Workforce Classification ............................................................................................ 3 Background ............................................................................................................................................. 3 Overview of the tool ............................................................................................................................... 4 Preparation ............................................................................................................................................. 5 The Facilitator ..................................................................................................................................... 5 Scope ................................................................................................................................................... 5 Initial data collection........................................................................................................................... 6 Choosing focus group participants ..................................................................................................... 6 Preparing participants............................................................................................................................. 6 Individual workforce rating ................................................................................................................. 7 The focus group meeting ........................................................................................................................ 7 Introduction .................................................................................................................................... 7 Discussion........................................................................................................................................ 7 Summary ......................................................................................................................................... 8 Follow-up ................................................................................................................................................ 8 Domain definitions.................................................................................................................................. 9 Service need ........................................................................................................................................ 9 Public profile ..................................................................................................................................... 10 Supply................................................................................................................................................ 11 Operational flexibility........................................................................................................................ 12 Operational capacity ......................................................................................................................... 13 Appendix 1 Scoring Matrix for Health Workforce Classification Framework ....................................... 14 Appendix 2 Template report initial data collection template .............................................................. 15 Appendix 3 Information for participants .............................................................................................. 16 Appendix 4 Copy of online survey. ....................................................................................................... 17 Appendix 5 Template Report Workforce assessment status................................................................ 20 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 that have lead to the development 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 New Zealand health system. The second driver was a desire to have an evidencebased 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 were been anecdotal and lacked a whole of systems approach. They did not 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 view of an expert 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 factors (figure 1) 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 enables views to be challenged and strong rationale to be developed to support 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 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 group discussion and ensure the facilitator is adequately prepared for the focus group process. Data can include relevant operational DHB information on the workforce, regulatory workforce data and strategic workforce information from Health Workforce New Zealand This information is shared with the focus group participants at the beginning of the process. The information will assist the participants to complete an individual assessment of the workforce and enable informed discussion on each of the 5 domains. During the focus group the facilitator keeps the group focused on discussing the rating, and rationale, for the workforce in each domain. Having rated each domain the scores are totalled and the workforce is assigned to one of four classifications 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 Preparation The Facilitator Each workforce assessment requires a leader or facilitator who is responsible for managing the process and facilitating the focus group discussion. This includes: Identifying the scope of the assessment Organising and collating the initial data collection The selection and invitation of focus group participants, Ensuring participants have the resources required to fully participate. Summarise the focus group discussions and overall findings. Managing any follow up investigation that may be required. The facilitator needs to be familiar with the process and have some skills in facilitation of group process. It is important that the facilitator fully understands the five factors and their purpose, so as to correctly guide discussion within the group. There is often a tendency for focus group members to digress into other topics, relevant to the workforce, not required for the purpose of the exercise. The facilitator must keep a tight handle on the topic of discussion and ensure that valuable time is not spent on superfluous items. The facilitator must also ensure that they are able to manage more vocal focus group members and ensure that a consensus is gained to weighting. They need to encourage feedback from quieter group members and ensure that all views are able to be represented. They must also pose challenges in the form of reflection questions if they feel that the group of particular members have started to focus on issues or areas of interest which are not relevant for the tool discussion. In summary the facilitator must take a ‘helicopter’ view of the topic and ensure that the focus group stays on task and topic. They must work to ensure all discussion remains centred around the tool and that issues of relevance are explored as able. Scope The first step of the assessment tool process is to identify the scope of the assessment to be performed. Usually this will be reviewing a workforce as a whole as is defined in the coverage clause of a particular employment agreement. Consideration may also be given to other workforce scopes such as Whole of workforce: general consideration of a specific workforce e.g. nursing, midwifery etc 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 dependency; low dependency The most common use of the tool is for a profession specific review. Initial data collection The aim of this step is to gather readily available background information/data on this workforce to help inform the group discussion and ensure the facilitator is adequately prepared for the focus group process. Data can include relevant operational DHB information on the workforce, regulatory workforce data and strategic workforce information from Health Workforce New Zealand. It should also include any indications of changes to service delivery models which may be considered in DHBs or within the MoH. The SER data team will coordinate the collection and preparation of this report using the template attached as appendix two. Choosing focus group participants 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. Ideally a focus group should have a minimum of 10 and a maximum of 20 participants in the focus group. In deciding the participants the following needs to be considered. the workforce being discussed other occupational groups service delivery geographic strategic and operational workforce views The facilitator is responsible for developing this group by sending out a request for volunteers through the led DHBs groups and by asking HWNZ,NHB and relevant professional groups if they would like to be involved. Depending on the group it may also be valuable to engage the training organisations. Preparing participants Because of the qualitative nature of this process it is essential that participants have all the information they need to ensure full and active participation. Participants must:1. Be clear on the scope of the workforce assessment 2. Understand the Health Workforce Classification Assessment tool and the importance of their role to the process 3. Have time to review the data that has been collected 4. First individually rate the workforce and send to the facilitator prior to focus group This is achieved by the facilitator sending out the participants hand book and the initial data collection report. Appendix three provides template email to participants. A follow-up phone call prior to the focus group to ensure understanding may also be useful. Individual workforce rating The first stage of the workforce assessment process is for the individual to decide an initial rating of the workforce. This is achieved through completion of an online survey. Once the facilitator has identified the focus group participants DHBSS admin staff will prepare the online survey and send a link to each of the participants. It will be the facilitators responsibility to follow up with participants to ensure they complete the survey. Participants are encouraged to provide the reasoning for the ratings they give. The results of the survey will be summarised and returned to the participants to use during the focus group meeting. The focus group meeting This meeting may be held both face to face or via a teleconference. The decision for which will be based on cost and practicality. It is useful to note that the process works equally well in either mode. Adequate time should be allocated to the teleconference/ meeting and approximately 60-90 minutes is sufficient to conduct the process. Introduction The meeting commences with the facilitator 1. Introducing the purpose of the meeting including the scope of the workforce being discussed 2. Introducing the group participants or enabling them to introduce themselves 3. Providing a reminder of the Health Workforce Classification Framework. This should include definitions of the five domains, the rating scale and final classifications. The scoring matrix (appendix 1) provides a prompt for this discussion and includes descriptions of the final classification. Discussion The focus group will spend most their time concentrating on completing the scoring matrix. This is the area of the tool which allows for group debate and for the cumulative scoring that results in the final classification. The facilitator will lead the group discussion on each dimension of the framework. This starts with service need and works across the matrix to end with operational capacity. The facilitator encourages the group to discuss which score the workforce in question should be given between 1 and 4, as well as rationale why. The need to have a diverse group of both operational and professional viewpoints is imperative here as it allows views to be challenged and strong rationale to be given in order to reach the final score. The facilitator skill here is the most important as they work with the group to achieve consensus on the final score. The group must reach agreement on the score (1-4) of each dimension before moving to the next dimension. Once each factor has been scored and the total tallied, the corresponding number should be found in the scoring table at the bottom of the matrix. This should be confirmed by the facilitator and the group asked to confirm they endorse the final classification reached. As the group works through the 5 domains the facilitator should take notes and ensure that areas which arise and are not covered by the 5 domains are noted for further investigation if warranted. The facilitator should also keep a record of the scoring of each of the 5 domains so as to tally the completed score to reach the overall classification. 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 total score should be matched to the table underneath the scoring matrix. Summary To complete the screening tool assessment process the facilitator should reconfirm the final classification reached. They should also reiterate any additional issues which have arisen from group discussion that require further investigation as part of any ER/IR processes. This 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 the workforce being reviewed. Follow-up Confirmation of the findings – a summary of written notes from the facilitator plus the final score and rationale should be emailed to all group members within a week of teleconference / meeting completion. Any follow up work from these findings should be agreed at this point also. All focus group members are required to review the sent items and send back any corrections to the facilitator within the space of 5-10 working days. Further analysis is now undertaken, on additional items which arose out of the focus group but were not particularly relevant to the workforce assessment tool. These are areas that can be expanded on and further investigated in the final operational analysis that is completed for the BSG. Domain 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 Rating Description 1 Service is stable and there are no anticipated major changes to service delivery or demand in the short term 2 Some instances of demand pressure on service but stable overall 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. Key Questions to support and encourage discussion: What is the current demand picture? Has the service changed significantly? Or is it about to? What is the current service picture? Example 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. 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 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 for inherently political workforces i.e. RMOs, SMOs, Midwives, and Medical Physicists. More common in autonomous than delegated workforce roles. Key Questions to support and encourage discussion: How politically sensitive is this workforce? Is it currently a high government priority? What are the current public sensitivities around this workforce? 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 mal-distribution? 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 1 No major distribution or supply issues 2 Some Distribution issues emerging and wider issues with supply 3 Distribution and supply issues increasingly impacting on wider system. Issues with overall size of workforce available. 4 Significant distribution and or supply issues currently occurring, problems with small size of available workforce. Example 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 Key Questions to support and encourage discussion: Is New Zealand currently training enough of this workforce at present? Do we need to increase current training ? What is overall supply like? Are their issues with particular geographic regions or areas within New Zealand? 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? Size 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/postgrad qualifications additional risk as longer lead in). Rating Description 1 No current workforce flexibility issues 2 3 4 Some Sector requirements to begin looking at alternative models of care and roles for this workforce Emerging requirements for more flexible workforce options Requirements for flexible workforce options, but very limited/no available substitute workforce that can perform the critical function of this workforce Example 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 Key Questions to support and encourage discussion: How flexible is this workforce in regards to its current scope? Can any other workforces fulfil the key tasks/ functions of this workforce? If so who? Would substitution of another workforce be a valid option into the medium to longer term? 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 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 4 Example 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 Long and often difficult recruitment processes for gaining sufficiently qualified individuals i.e. 1-2 years for recruitment Key Questions to support and encourage discussion: What is overall national retention of this workforce like at present? Are there areas where issues are occurring? If so where and why? What is the lead time for recruitment of this workforce? To what degree do we need to import internationally for this workforce? And why is this? Appendix 1 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) Appendix 2 Template report initial data collection template Data Required Where From Details Current Workforce Base Data – employees on DHB payroll HWIP/DHBSS Workforce Headcount in DHBs Employment Status – full-time, part-time, casual General demographics – sex, age, length of service, ethnicity, etc. Current Workforce Base Data – employees on contract to DHB DHB Contracting (Planning and Funding) or via GMsHR and HWIP as a specific data request Headcount of staff covered within contract General demographics – sex, age, length of service, ethnicity, etc. Current Workforce Base Data – outside of DHBs HWNZ Registration Authorities data Workforce Headcount outside of the DHBs Employment Status – full-time, part-time, casual General demographics – sex, age, length of service, ethnicity, etc. Recruitment and Retention HWIP/DHBSS HWNZ Department of Labour NZ Stats DHB employed workforce - Entry and exit data (if available) Information from service reviews (if available) General population workforce data General population workforce data Vacancies HWIP/DHBSS HWNZ Department of Labour NZ Stats DHB employed workforce - Entry and exit data Information from service reviews General population workforce data General population workforce data Service Demand Data HWNZ Specific section with the MoH Service Reviews/Forecasting/strategies Strategies Supply and Training Data HWNZ Colleges Registration Authorities Numbers of those in training and at what level (can cross check all data from these sources) Appendix 3 Information for participants Name Particular workforce Facilitator Email body Thanks for agreeing to participate in the assessment of the XXX workforce. You have been chosen because of your particular knowledge and skills. This is a qualitative process that and the outcome is reliant on robust discussion during the group decision making process. As a participant in this process you will need to: Review the participants handbook and make contact with xxxx if you are unsure of what is expected of you Review the current state overview that is appended to this email Complete the on-line survey. The results of this survey will be used to inform the focus group discussions. You will shortly receive an email with a link to the survey. Attend the focus group teleconference Read and comment on the draft report. This report once finalised will be shared with DHBs and be used to inform the development of the bargaining strategy Date of survey close off. Date of focus meeting Inclusion Participants guide Current state overview List of other people involved in the process Appendix 4 Copy of online survey. Appendix 5 Template Report Workforce assessment status Advice to the Bargaining Strategy Group: (insert relevant workforce) Purpose Employment Relations is a key accountability for DHBs and has a significant impact on DHB outcomes. The Employment Relations Strategy Group (ERSG) has an operational governance role over 20DHB ER activity and has mandated a range of advice to ensure that development of bargaining strategy is well supported. Operational advice on the employed workforce is developed by DHB experts and is complementary to the strategic advice provided by Health Workforce New Zealand (HWNZ) The purpose of the operational advice is to ensure that Bargaining Strategy Groups have access to accurate information on the current status of the DHB employed workforce. The purpose is to identify any staffing capacity and/or capability issues related to DHB operational delivery and/or service development needs, some of which may be addressed through the ER process. This paper provides summary advice to the ERSG and the Bargaining Strategy Group on the current status of the DHB (insert relevant workforce). Context This advice is provided for the purpose of informing the development of a bargaining strategy for the (insert relevant workforce) MECA – expiry date (add) Current Status of the DHB (insert workforce) The current status of the (insert workforce) was assessed by sector experts using a structured screening tool. The screening tool assigns a score to the workforce being considered according to: The operational stability/instability of the service The sensitivity of the workforce in terms of media interest and public confidence Demographic factors impacting on the overall availability this workforce Operational flexibility around this workforce for service delivery & innovation Recruitment and retention The purpose is to provide an overall assessment of the workforce to inform the ERSG and Bargaining Strategy Groups on any pressures impacting on a workforce operationally and/or in the context of employment negotiations. Results of the screening place the workforce in one of 4 categories as shown in the figure below. Results should be considered indicative only. Preliminary assessment of the current status of the DHB (insert workforce) by sector experts has identified the DHB (insert workforce) as (insert scoring). Stable Occupation: WATCHING BRIEF Transitional Occupation: SOME INTERVENTION RECOMMENDED Transitional/ Occupation Under Pressure: INTEVENTION REQUIRED Occupation Under Pressure: INTERVENTION IMPERATIVE Rationale (add detail) Further detail of the assessment is summarised in the table below: Key Working well / no current problems, no immediate action required Moderate alert, action required in short / medium term High alert, immediate action required, extreme risk to occupation group Current Status – Summary of Key Service, Operational Workforce and Employment Drivers (example below) 1 2 3 Operational Service Needs Current Relatively stable nationally 12 month outlook No major changes foreseen 1-3 years outlook Watching brief in regards to increased complexity and increased referrals Employed Workforce structure Average age Average workforce average (44 years) Ethnicity Lack of Maori and Pacific MRTs (demography) Gender balance Predominantly female so high part time workforce and loss of workforce numbers during childbearing years Recruitment Current vacancies Issues exist Average time to fill Acceptable Distribution No major issues identified Pressures on related workforces No major issues identified 4 Retention Factors Turnover Relatively stable Sick Leave No reports of current issues Part-time /Fulltime High part time workforce which can be problematic in regards to availability Skill Mix Issues with having adequately experienced skill mix in all areas, particularly with modalities Access to Clinical leadership Relatively good access to clinical leadership Clear career path No issues identified development 5 Ongoing Training and Development Workload management Difficult in certain areas Roster management Difficult in certain areas Performance development mechanisms No reported issues Entry/ Transition competency No reported issues Match to service requirements No reported issues Access to on going training (progression) Some reported issues Access to training to maintain practising cert No reported issues Key Issues The observations below highlight likely trends that are impacting on employers based on sector expert views and currently available workforce information. Service Delivery & Development Drivers Demand: (add relevant information) Employment Drivers (add relevant information) Training and Development (add relevant information) Recommendations It is recommended that the ERSG / Bargaining Strategy Group consider the following: (add 4-5 high level recommendations) Operational Workforce Analysis Workforce Description Regulation and Scopes of Practice (add information) Entry Qualification (add information) Key Service, Operational Workforce and Employment Drivers (add) Service Delivery & Development Drivers: (add) Demographics The following demographics represent data from the collective DHB picture. (add information ) Current employed workforce As well as service driven factors, DHB requirements for (insert) workforce are influenced by the characteristics of the current workforce: Recruitment (add) Distribution: (add) Vacancies: (add) Retention (add) Workload Management: (add) Workforce Mix: (add) Clinical Leadership: (add) Training and Development Entry/ Transition Competency: (add) Match to Service Requirements: (add) Access to On-going Training (progression): (add)