rethinking healthcare workforce planning
TRANSCRIPT
Rethinking healthcare workforce planning
Dr. Graham WillisHead of Research and Development, CfWIE: [email protected]: +44(0)78 1234 0405
Main points
Consider the unpredictability of the futurePresent uncertainty to decision makers
Model skills and competences not numbersUnderstand what drives future demand
Use scenarios to capture uncertaintyStress test before you implement
How many doctors do we need?
Do we trust this?
Trai
ned
hosp
ital d
octo
rs
(tho
usan
ds)
60
50
40
30
Year2014 2040
Supply
Demand
?
Policy
What if the future is not what we expect?
Failure
Megatrends
ProblemSystem
Events
Consider many futures…
TodayReference
future
Use plausible, challenging and consistent futures to test policies
Robust workforce planning
Understand the system
Imaginethe future
Stress testinterventions
Shape yourfuture
Focal question
Transparent and participatory
Horizon scanning
Contextualanalysis
Issues
Factors
Events
ProbabilityImpactWorkforceStakeholder
Ideas about the future
Systemic analysis
Scenario generationStakeholder workshops
Influencing factors
Keyfactors
Consistency check
Narrative scenarios
Quantified scenarios
Scenario generation workshopKey factors
Low
I
mpa
ct H
igh
Low Uncertainty High
Predetermined Key factors
Secondary
Scenario generation workshop
Population GDP growth Energy usage Carbonemissions
High
Low CA
B
Consistency analysis
Scenario generation workshop
Vary across different futures
Formal elicitation protocol
Monte Carlo simulation Prob
abili
ty
Value
Quantify critical parameters
Modeling and simulation
Demand side
OutputsSupply
side
Pharmacy exampleScenarios
Scenario 1Narrower
Scenario 2Internet-driven
Scenario 3Broader
Pharmacists role
Enabling technology
Projection 1
Projection 2 Scenario 4e-Pharmacy
Num
ber o
f pha
rmac
ists (
full-
time
equi
vale
nt)
2012
2014
2016
2018
2020
2022
2024
2026
2028
2030
2032
2034
2036
2038
2040
100,000
80,000
60,000
40,000
20,000
0
2012
2014
2016
2018
2020
2022
2024
2026
2028
2030
2032
2034
2036
2038
2040
100,000
80,000
60,000
40,000
20,000
0
2012
2014
2016
2018
2020
2022
2024
2026
2028
2030
2032
2034
2036
2038
2040
100,000
80,000
60,000
40,000
20,000
0
2012
2014
2016
2018
2020
2022
2024
2026
2028
2030
2032
2034
2036
2038
2040
100,000
80,000
60,000
40,000
20,000
0
Year
Scenario 1
Scenario 3
Scenario 2
Scenario 4
Pharmacy exampleHow uncertain is the future?
Pharmacy examplePolicy options
-20%
-35%
-50%
-5% -10%-15%
A B C D E F
+3%
One-off supply reduction Phased supply reductionthen balancing increase
5 Years 10 Years
Polic
y ou
tcom
es
Pharmacy examplePolicy analysis
Today
2
31
4
Policy options: ABCDEF
1. Focusing on numbers is not enough.2. We don’t know what skills and
competences are needed in future.3. We don’t know who is best to
provide them.4. We don’t know what drives demand.
Some embarrassing admissions...
What about the rest of the system?HealthPublic healthSocial care
2%
98%Workforces not yet
modelled
Workforces modelled to date
What about the rest of the system?HealthPublic healthSocial care 10% Other health and
support
21% Paid adult care and support
24%Volunteer adult care and support
43%
Unpaid adult care and support
2% Workforces modelled to date
Skills and competences framework
Competences
Skills
FacilitationLeadershipWellbeing
Knowledge Personal
Types of skillPrevent, Enable, Assess, Plan, Treat, Rehabilitate, Relieve, Link
Level of skill1 to 6 representing intensity, experience and accountability
Quantitative skills
Qualitative skills
A new challenge: Horizon 2035
Today
What skills and competences do we have?
What might we need in future?
Step-by-step process1. What skills does your workforce have
today?2. What drives the demand for skills?3. How does the workforce meet this
demand?4. How does skills demand change by
2035?
1. What skills does your workforce have today?
Prevent
Enable
Assess
Plan
Treat
Rehabilitate
Relieve
Link
Unpaid adult social care workforce
Nurses
Dentists
Medical generalists
Medical specialists
Volunteer care and support workforce
Other workforce groups
Workforce groups
Popu
latio
n
Learning disabilities
Oral health
Singular demand for service
Maternal and perinatal
Infectious disease
Mental long-term conditions
Physical long-term conditions
2. What drives the demand for skills?
Popu
latio
n
Learning disabilities
Oral health
Singular demand for service
Maternal and perinatal
Infectious disease
Mental long-term conditions
Physical long-term conditions
Skill level: 1 2 3 4 5
3. How does the workforce meet this demand?
Prevent
Enable
Assess
Plan
Treat
Rehabilitate
Relieve
Link
Unpaid adult social care workforce
Nurses
Dentists
Medical generalists
Medical specialists
Volunteer care and support workforce
Other workforce groups
Workforce groups Increasing concentration and experience
Skill typeDemand source
Skill level654321Prevent
Enable Assess
Plan Treat
Rehabilitate Relieve
Link
Maternal and perinatal demandSingular demand for servicesPhysical long term conditionsMental long term ConditionsLearning disabilitiesOral healthInfectious disease
Example: Level 5 link skills associated with infectious disease. This could include public health consultants liaising with community services and stakeholders to deliver public health programmes.
Multidimensional problem
How demand is met today
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%% of Total Hours
Healthcare
Public Health
Social Care
Grand Total
10%
11%
35%
35%
21%
24%
24%
35%
68%
59%
10%
25%
8%
9%
6%6%
5%
Physical LTC
Mental LTC
Learningdisabilities
Oralhealth
InfectiousdiseasesMaternity Singular
demand
How demand is met today
0% 20% 40% 60% 80% 100%% of Total Hours
Healthcare
Health - Bands 1-4
Health - Dental Care Professionals
Health - Dentists
Health - GPs
Health - Medical Specialists
Health - Midwives
Health - Nurses (excl. PH and SC nurses)
Health - Other Health Care Professionals &AHPs
Health - Pharmacists
PublicHealth
Public Health - Consultants
Public Health - Nurses
Public Health - Practitioners
SocialCare
Social Care - Paid Care and Support Workersnot requiring professional registrationSocial Care - Paid Care and Support Workersrequiring professional registration
Social Care - Unpaid Carers
Social Care - Volunteer Care and SupportWorkers
100%
100%
100%
25%
20%
37%
22%
20%
43%
38%
20%
22%
22%
29%
29%
24%
20%20%
29%
25%
38%
23%
32%
20%
10%
10%
10%
35%
35%
35%
35%
35%
35%
10%
10%
10%
8%
8%
8%
11%
11%
11%
11%
21%
21%
21%
21%
68%
68%
68%
68%
0M 1M 2MFTE (approx)
Percentage of hours by demand source
Physical LTC
Mental LTC
Learning disabilities
Oral health
Infectious diseases
Maternity
Singular demand
Sources of uncertaintyQuantifying critical parameters
Reference future: Level 5
-
2
4
6
8
10
12
14
16
ALL Lifeexpectancy
Fertility Migration Wellness Productivity
Key:
median
Hour
s in
2035
(bill
ions
)
4. How does skills demand change?Reference future
Median
80% confidence bounds
100% confidence bounds
9.3 billion hours FTE: 5,735,000
12.7 billion hours FTE: 7,772,000
CHANGE:Hours: 3.3BnFTE: 2,037,000 +36%
4. How does skills demand change?Monte Carlo simulation
x
20132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035
10B
11B
12B
13B
14B
Hours
Different futuresSix narrative and quantified scenarios
Different futures
2016 2021 2026 2031 2036
Year
0B
2B
4B
6B
8B
10B
12B
14B
Hours
1 Populationmod
2 Populationand
wellnessmod
3Population,Wellness
and Serivcemod
4Population,Wellness,
Service andProductivity
mod
Components of change: business as usual
Popu
latio
n
Wel
lnes
s
Serv
ice
Prod
uctiv
ity
9.3Bn
12.7Bn
+36%
(median projections)
Change in demand by skill hours
Change in demand by skill type
Main points
Consider the unpredictability of the futurePresent uncertainty to decision makers
Model skills and competences not numbersUnderstand what drives future demand
Use scenarios to capture uncertaintyStress test before you implement
Next steps
What is the optimal mix of skills?To minimise cost? To maximise flexibility?
Can we standardise scenarios?Socio-technological-economic and wellbeing futures?
New robust planning framework
Scenario matrix framework
More information
Horizon 2035 Future demand for skills: Initial results
http://www.cfwi.org.uk/publications/horizon-2035-future-demand-for-skills-initial-results
tRethinking workforce planning for the future
Dr. Graham WillisHead of Research and Development, CfWIE: [email protected]: +44(0)78 1234 0405