Providing Operational Advice Process
into ER Negotiations
May 2012
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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
FW informants, A,T&S Strategy Group,
prioritisation for 44+ workforces
Action research approach to development
Rationale: consistency, standardised, endorsed,
adaptable approach
Iterative development
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The need for more suitable frameworks for health
workforce monitoring and development not new
Previous 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 view
Provision of evidence to make better informed ER and
IR decisions, specifically with MECA agreements
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Identify areas of operational pressure where
intervention may be required
Use 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-Micro
Tool is time dependent - however has ability
to repeat the process at a later date in order
to review any changes or other such trends
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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.
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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 problem
Interviews – DHBNZ 2011
Prototype – pilot testing
Delphi – 3 round testing
Operational Capacity
Service Need
R&R
Service Stability
Lead in time
Model of Care
/Clinical Processes
Specificity of skills
Public Profile
Operational Flexibility
Public Confidence
Regulatory
Political/policy context
Education & training
Qualifications/Flexibility
Labour market
positioning
Supply
Size & Distribution
Gender/ ethnicity /age
1
2
3
4
Service Needs
Public Profile
Supply
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.
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.
Service 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.
Service 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.
Operational Flexibility
Operational
Capacity
No current requirement for
workforce flexibility for this
occupational group. Some
workforce substitution
available.
Emerging requirement to
begin looking at innovation
and role changes for this
workforce and/or related
workforce (substitution
options).
There is a requirement for
more flexible workforce
options. Some substitution
and/or workplace
innovation reducing current
pressures
No recruitment and
retention issues.
Requirement for flexible
workforce options, but very
limited/ no available
substitute workforce that
can perform the critical
functions of this workforce.
Some recruitment and
retention issues are
occurring.
Generalised recruitment
and retention issues.
Operational environment
is affected by gaps in
this workforce due to the
specialised skills they
have
Significant recruitment
and retention issues .
Scarcity of workforce is
compromising
operational
environment.
Overall Scoring
Stable Occupation:
5-8
WATCHING BRIEF
9-13
Transitional Occupation:
SOME INTERVENTION RECOMMENDED
14-17
Transitional/ Occupation Under Pressure:
INTEVENTION REQUIRED
18- 20
Occupation Under Pressure:
INTERVENTION IMPERATIVE
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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
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Agree facilitator
Lead 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.
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Establish a focus group
Sector health experts
Multidisciplinary if possible, include adequate
representation from the workforce being
discussed
Approximately 10-20 participants in the focus
group in total
Should 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.
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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.
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Can be conducted either face to face or by
teleconference. Teleconference is a preferred
method and can facilitate the assessment tool
process well
Approximately 60-90 minutes should be
sufficient to conduct the process.
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The 5 domains
Workforce classification – provide an overview
of the four potential outcomes of scoring;
stable , transitional, transitional /
underpressure, underpressure
Scoring matrix
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Reconfirm final classification reached
Reiterate 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.
Operational Advice Process
Gather Information
Semi-structured
Confirm Themes
Test
Refine Themes
Test
Conversation using
Preliminary
Endorsement
assessment tool
Focus group members
Agree
Focus Group
Focus Group
Employed workforce data and analysis / existing information, reports
Bargaining
Strategy Group
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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 occur
Attention should be given to ensure data
gathering and other forms of workforce review
are undertaken
Used a best proxy to link wide sector views,
underpinned by operational evidence and HR
data sources.
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2.
3.
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?
 What
worked, what didn’t?
 Information gathering
conclusions
 Focus group suggestions
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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)
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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).
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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).
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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
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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.