ARCHIVED - Health Human Resource Connection, #5

Health Human Resource Strategies Division
Health Care Policy Directorate
Health Canada
May 2008
ISSN 1911-8309

Welcome to the fifth edition of Health Human Resource (HHR) Connection, an electronic newsletter, produced by the Health Human Resource Strategies Division (HHRSD) of the Health Care Policy Directorate of Health Canada.

This issue of HHR Connection showcases the Health Human Resources 2007: Connecting Issues and People conference, which took place December 4 to 6, 2007, at the Crowne Plaza Hotel in Ottawa. The conference program is available online.

A brief synopsis of A Framework for Collaborative Pan-Canadian Health Human Resources Planning and highlights from the HHR Strategy and Internationally Educated Health
Professionals Initiative (IEHPI) are listed at the end of this newsletter.

To subscribe or send comments about the newsletter, please email: hhrconnection-connexionrhs@hc-sc.gc.ca.

Contribution Program is Renewed

In February 2008 the Terms and Conditions for the Health Care Policy Contribution Program (HCPCP) were renewed for the period of April 1, 2008 to March 2013.

The HCPCP encompasses five components, including the HHR Strategy, IEHPI, the National Wait Times Initiative, the Patient Wait Times Guarantee Pilot Project Fund and core contributions that support health policy issues, such as primary health care, chronic care, home and continuing care, and palliative and end-of-life care. Renewal of the Terms and Conditions allows the HCPCP to continue funding all components and their respective health care policy projects.

Over the next five years, the HCPCP will implement a new performance and risk management strategy so the Program can improve processes and better demonstrate achievement of outcomes. Health Canada is developing performance indicators, evaluation tools and training materials to assist staff and funding recipients with data collection and reporting.

The HCPCP will also address recommendations from the summative evaluation of the Program, which was conducted as part of the renewal process. An update on the Program evaluation and implementation of the new performance and risk management strategies will be provided in the next newsletter.

Inaugural HHR Conference hosted in Ottawa

Health Human Resources 2007: Connecting Issues and People brought together over 300 health professionals, planners and researchers from across Canada and was hosted by the Canadian Institute for Health Information in partnership with Health Canada, the Public Health Agency of Canada, and the Canadian Institutes of Health Research.

The conference highlighted the connections between HHR initiatives at the national, provincial, regional and local levels. It focused on strengthening relationships among key groups who have a vested interest in HHR research, management and planning; showcasing initiatives on HHR planning "in the trenches"; and highlighting the current state of HHR data and proposed directions in response to common issues and challenges.

For more information contact: hhr@cihi.ca.

An Aboriginal Thread weaves through the Conference

During each of the three days of the conference, an Aboriginal perspective was featured throughout workshops and presentations.

The conference featured four key themes for the concurrent sessions: Recruitment and Retention; Data, Research and Knowledge Translation; Linking Education with HHR; and Getting the Right Mix.  Representatives from the Aboriginal Health Human Resources Initiative (AHHRI) were part of the conference's planning team.

Day 1

Senior manager of the AHHRI, Simon Brascoupé, made a presentation on the initiative during the pre-workshop entitled Recent Developments in Pan-Canadian HHR Planning in Canada.  Mr. Brascoupé expanded on the AHHRI and its links with the HHR Strategy. The AHHRI, was introduced in 2004, and is intended to improve the health status of Aboriginal people and better adapt health services to meet their needs. Specifically, the Strategy is designed to increase the number of Aboriginal people working in health-related fields, improve cultural competencies of those providing services to First Nations, Inuit and Métis, and improve the retention of healthcare workers.

Day 2

Emily Lecompte (Doctoral candidate), Cleo Big Eagle and Kate Humpage (Director within Aboriginal Affairs Directorate at Human Resources and Social Development Canada) made a presentation on Demographic and Workplace Issues Concerning Aboriginal Health. They compared 1996 and 2001 census data on Aboriginal people and highlighted trends related to Aboriginal health professionals in Canada. One trend is an increase of Aboriginal people in the healthcare workforce.

A plenary session, called Perspectives on Privacy in HHR, brought another Aboriginal perspective to the HHR conference. Krista Yao, an attorney of law at the Nadjiwan Law Office, North Bay, Ontario, presented Ownership, Control, Access, and Possession principles, and discussed the potential harm of breaching community privacy while doing research. Ms. Yao also explained the historical reasons why Aboriginal people are apprehensive about the activities of researchers.

Day 3

Steven Vanloffeld from the National Aboriginal Health Organization participated in the session called The Great Debate. The topic debated was "Are we managing HHR in Canada better than we were 10 years ago?"

He demonstrated that there is a lack of longitudinal data in Aboriginal HHR, expanded on the challenges that need to be addressed in Aboriginal HHR, and the progress that has been made since 2004.

An Aboriginal perspective was also included in the Panel Discussion: Spotlight on Entry-to-Practice Credentials. P. Gaye Hanson from Hanson and Associates presented the issues regarding entry-to-practice credentials amongst Aboriginals. She elaborated on the fact that Aboriginal students come from a diverse background and different urban, rural and remote geographic regions. She also noted that it is difficult for some Aboriginal students to access health programs that require more than a baccalaureate degree (i.e. masters) in order to pursue healthcare careers.

Dr. John B. Izzo mentioned during his presentation Renewing the Heart of Healthcare: Creating a Culture of Belonging and Excellence that it is important to focus on the soul of worthy workplaces and the spirit as 'good medicine.' He noted that culture, spirituality and medicine should work together in order to improve the heart of healthcare, especially among Aboriginal people.

HHR in the Americas - Key Challenges and Regional Goals

The Pan American Health Organization (PAHO) is an international public health agency with more than 100 years of experience in working to improve health and living standards of the countries of the Americas. It also serves as the Regional Office for the Americas of the World Health Organization and enjoys international recognition as part of the United Nations system.

PAHO's overall objective is to assist each country in the Americas with achieving equitable access for all people to an adequately trained, motivated, and sustainable health workforce that contributes to attaining the highest possible level of health care.

The following article is based on the presentation by Dr. Felix Rigoli and Marie-Gloriose Ingabire of PAHO at the Canadian Institute for Health Information's Health Human Resources 2007 conference. They discussed regional goals and challenges within the Americas.

Trends in HHR

The 2006 World Health Report, entitled Working Together for Health, estimated that there are 59.2 million full-time paid health workers worldwide (health service providers, health management and support workers) of whom over 21.7 million (36.6 percent) are in the Americas.

Based on the study by the Joint Learning Initiative in 2004, the World Health Report also suggests that a minimum density of HHR (doctors, nurses and midwives) per population is 25 per 10,000 population.

This ratio to population measure has its limits. Over and above the ratio, factors such as the organization of health services, the employment status of health workers, their skills and staff mixes, and their work environments play a very important role in determining the impact health workers have on the health outcomes of the populations they serve.

Notwithstanding its limitations, this ratio provides some indication of the overall availability of health workers and can provide a rough measure for international comparability.

In 2000, over 163 million people in the Americas resided in areas where the HHR density was below the desirable target level of 25 per 10,000 as identified by the World Health Organization.

Many countries in the Americas are facing HHR challenges such as maldistribution, inappropriate competencies and skills to respond to the health needs of the population, as well as poor working conditions.

Graphs on page 4 show the high predominance of physicians versus nurses in Latin America and the geographical maldistribution observed in selected countries with relatively more physicians in urban than rural areas.

The Toronto Call to Action

The magnitude of HHR challenges faced by countries in the Americas calls for significant changes and innovative interventions, including multisectoral effort among the health, education, labour and finance sectors that promote collaboration between governmental and non-governmental actors, noted PAHO's presenters.

Five critical challenges identified during the Seventh Regional Meeting of the Observatories of Human Resources for Health held in Toronto, Canada, in October 2005, became the common platform for the Toronto Call to Action for a Decade of Health Human Resources for Health.

The Toronto Call to Action is a commitment from countries in the Americas to address key commonly-identified HHR challenges. More information is online at the Observatory of Human Resources website.

The Toronto Call to Action calls for long-range evidence-based policies and plans; the right people in the right place; strong linkages between training institutions and health-service delivery institutions; improved working conditions; incentives for healthy environments; and ways to implementing retention strategies for health workers.

Source: Pan American Health Organization, Health Analysis and Information Systems, 2001-2005. Washington, D.C., 2005.

Source: Pan American Health Organization, Health Analysis and Information Systems, 2001-2005. Washington, D.C., 2005.

During the Pan American Sanitary Conference in October 2007, all countries in the Region approved a resolution with 20 goals for HHR from 2007-2015. They were organized according to the five key challenges identified in the Health Agenda for the Americas and the Toronto Call to Action. The regional goals report can be viewed online.

The five challenges and the related 20 goals are located below.

The goals represent a renewed willingness and commitment from countries in the Americas to move collectively in addressing HHR issues. The goals recommend primary health care as the health delivery model. They are deliberately high level and non-prescriptive, so that each country is able to choose which ones are relevant to its context, adapt them, and define and establish appropriate indicators for baseline data and monitoring progress.

In helping countries achieve these commitments, PAHO has coordinated various initiatives in collaboration with its partners, including:

A needs-based HHR planning methodology which is being implemented in Jamaica and Brazil, in collaboration with Dalhousie University. The project is led by Dr. Gail Tomblin Murphy.

HHR Unit studies have been conducted at national levels in over 15 countries across the Americas focused on health care system design, function and resources.

Other PAHO initiatives include the development of a HHR Planning and Management course to strengthen each country's internal capacity for better evidence-based planning, and effective and efficient management of HHR.  This course is being developed for the English-speaking Caribbean, and will be extended to other countries later.

Another project involves data management and aims to build capacity in countries to collect data, while at the same time assessing the data quality. Selected countries in the Caribbean (Barbados, Belize, Eastern Caribbean countries, Jamaica, and Trinidad and Tobago) constitute the first wave for this project in the Region and results will be disseminated.

PAHO initiatives respond to requests from countries, and are developed and implemented at each country's pace. Canadian involvement is responsive and tailored to requests.

Further updates on the collaborative activities between Health Canada and PAHO will be provided in future HHR Connection newsletters.

In the meantime, if you are interested in finding out about PAHO's HHR initiatives, please contact Marie-Gloriose Ingabire at ingabirm@paho.org.

Canada's First Framework for Collaborative Pan-Canadian HHR Planning: A Brief Synopsis

In 2004/05, the Advisory Committee on Health Delivery and Human Resources (ACHDHR) developed Canada's first Pan-Canadian Framework for a collaborative approach to HHR planning. The Framework was approved by Ministers of Health in October 2005.

In 2006, federal/provincial/territorial (F/P/T) governments also consulted with stakeholder groups (e.g., research entities, national Aboriginal organizations, health organizations/associations, regulatory bodies) using web-based consultations and face-to-face meetings. These consultations provided insights into how stakeholders can support, contribute and implement the Framework's Action Plan.

The Framework is presently a tool used by provinces and territories when examining their own HHR needs. It was recognized by keynote speakers at the Canadian Institute for Health Information's Health Human Resources 2007 conference as a significant HHR planning resource.

Key Goals of the Framework

Through the new pan-Canadian approach to HHR planning, each jurisdiction* will continue to plan its own health care system, develop its own service delivery models, and develop and implement its own HHR policies and plans. However, it will do so in the context of a larger system that shares information and works collaboratively to develop the optimum mix and number of providers to meet all jurisdictional needs. The goal of the Framework is to develop and maintain a health workforce that will support health care renewal.

*The province of Québec considers HHR planning its exclusive provincial responsibility.  It did not participate in the development of this report, nor does it intend to participate in a pan-Canadian strategy for collaborative HHR planning. However, Québec remains open to sharing information and best practices with other jurisdictions.

Current Challenges in HHR Planning

There are two key differences between the current pan-Canadian approach and the traditional approach to HHR planning. The first is collaboration.  Historically, each province and territory in Canada has worked independently to design its service system, develop service delivery models and HHR plans.

This has resulted in competition between jurisdictions, which leads to limited human resources. Within the Framework, each jurisdiction will continue to plan its own health care system while sharing information and working collaboratively.

The second difference is that the current plan is driven by changing population health needs.  Traditionally, the approach to HHR planning in Canada has relied on an analysis of past trends that respond to short-term concerns. For example, when faced with shortages in a certain profession, jurisdictions tend to add training positions; faced with surpluses, they cut training positions; faced with budget pressures, employers cut or reduce full-time positions. The problem with this approach is that planning focuses on the past instead of the future without considering new ways of delivering service, and it is based on weak data and questionable assumptions.

Benefits of a F/P/T Approach to Planning

The immediate advantages include:

Greater capacity to implement policies, identify priorities and improve access to quality health care services at a sustainable cost.

Greater ability to share best practices, determine population health care needs, influence the factors that drive the health care system, and improve health outcomes.

Less costly duplication in F/P/T planning activities, such as forecasting and simulation models.

Improved collaboration among jurisdictions to support collective bargaining processes regarding compensation.

Greater understanding of the interjurisdictional and national perspectives surrounding HHR results in better decisions about ensuring Canadians have an adequate supply of physicians, nurses and other health care workers.

Ensures the Canadian health system is less vulnerable to global pressures.

The Action Plan

The Action Plan includes principles to facilitate collaboration among jurisdictions and has the following goals:

To improve all jurisdictions' capacity to plan for the optimal number, mix, and distribution of health care providers based on system design, service delivery models, and population health needs.

To enhance all jurisdictions' capacity to work closely with employers and the education system to develop a health workforce that has the skills and competencies to provide safe, high quality care, work in innovative environments, and respond to changing health care system and population health needs.

To enhance all jurisdictions' capacity to achieve the appropriate mix of health providers and deploy them in service delivery models, which make full use of their skills.

To enhance all jurisdictions' capacity to build and maintain a sustainable workforce in healthy, safe work environments.
 
To view a copy of the Framework and Action Plan, visit the Health Human Resource Strategies Division's website.

Examining the progress of the Health Human Resource Strategy and Internationally Educated Health Professionals Initiative

In 2003 and 2004, federal/provincial/territorial governments acknowledged the need to increase the supply of health care professionals in Canada.

By 2004, each government committed to developing an HHR action plan based on an assessment of gaps within their own jurisdiction. However, no collective targets for recruitment or training within specific professions were set.

Federal financial support for HHR continues to be provided through the HHR Strategy and IEHPI. Initiatives complement the direct investments of provincial and territorial governments through the development of HHR data and forecasting models; policy research; identification and dissemination of innovative models/practices; and enhanced capacity for collaboration by the range of partners responsible for HHR.

Health Canada continues to work with the provinces, territories and other key health-related organizations to improve the planning and coordination of Canada's HHR.

The remaining pages of this newsletter outline objectives, activities and accomplishments for the various components of the Strategy and the IEHPI over the last five years.

A more detailed description of each initiative can be found within annual reports posted on the Health Human Resource Strategies Division's website.

Health Human Resource Planning

The HHR Planning component of the Strategy is strengthening the evidence-base and
F/P/T capacity for HHR planning by providing funding towards HHR data development with organizations, such as the Canadian Institute of Health Information (CIHI) and Statistics Canada.

Some accomplishments to date include:

- Creation of national supply-based databases for pharmacists, occupational therapists, physiotherapists, medical laboratory technologists, and medical radiation technologists by CIHI.

- Development of A Framework for Collaborative Pan-Canadian Health Human Resources Planning, which establishes a pan-Canadian collaborative approach to planning and identifies priorities for collaborative and jurisdiction specific action to achieve a more stable, effective health workforce.

Interprofessional Education for Collaborative Patient Centred Practice Initiative (IECPCP)

The IECPCP Initiative facilitates the adoption of interprofessional education across all health care sectors by providing funding via agreements with 20 educational institutions across the country to develop curriculum for interprofessional collaborative practice for both students and health care providers. In addition, 12 complementary projects have been funded to address systemic barriers to the implementation and sustainability of IECPCP in Canada.

Some accomplishments to date include:

- Development of interprofessional curricula for classroom and clinical settings that has led to an increase in the number of educational institutions providing mandatory interprofessional education courses (e.g., Memorial University has developed pre-licensure course materials for medical, nursing, pharmacy and social work students).
- Established the Canadian Interprofessional Health Collaborative as the focal point for best practice identification, dissemination, and knowledge translation in the area of IECPCP.
- Supported the establishment of the National Health Sciences Students' Association (January 2005).

Aboriginal Component of the HHR Strategy

The Aboriginal component of the Strategy meets the unique health service needs of
First Nations and Inuit by focusing on health career recruitment and promotion. Since
2004, the Strategy has provided funding to 14 projects, primarily through national
Aboriginal organizations, to focus on health careers awareness and promotion to
increase the number of First Nations and Inuit youth being able to enter into health careers.

Some accomplishments to date include:

- Completed a draft of an Aboriginal specific Health Human Resource Minimum
Data Set to support HHR planning.
- Supported the National Aboriginal Achievement Foundation's "Health Careers in the Classroom" and Blueprint for the Future.

Recruitment and Retention

Improving the workplace health and increasing the supply, diversity and distribution of health care providers is another key component of the Strategy. Health Canada
supports 47 agreements conducted by a broad range of national and jurisdictional
stakeholders, including the Canadian Medical Association, the Canadian Nurses
Association, the Association of Faculties of Medicine of Canada, the College of
Family Physicians of Canada, and the Canadian Pharmacists Association.
This work was initiated to address healthy workplace interventions, supply, diversity
and distribution of health care providers.

Some accomplishments to date include:

- Increased support for family physicians in primary care, promotional strategies to enhance the image of family medicine, and collaborative action on intraprofessionalism to build stronger relationships between family physicians and specialists.

- Enhanced stakeholder collaboration to increase support and promotion of health care careers.

- Began the review of medical education in Canada based on current and future
needs in order to promote excellence in patient care by reforming the medical education system.

- Created the Quality Worklife - Quality Healthcare Collaborative and a strategy to improve the quality of worklife for Canadian health care providers to support health system delivery and patient outcomes.

- Enhanced the evidence-base to show that healthy workplace interventions make a difference to the health of front-line workers (e.g. demonstrated reductions in absenteeism and injury among health care workers as well as their related costs).

- Supported an intensive consultation process at six sites across Canada to enhance interprofessional collaboration by consulting with pharmacists, physicians, nurses, and a number of other health care professionals on the future role of pharmacists and the changes required to strengthen the profession's alignment with the health care needs of Canadians to respond to stresses on the health care system.

The Internationally Educated Health Professionals Initiative (IEHPI)

Highly qualified immigrant health professionals face serious challenges in putting their skills to work in Canada's health care system. At the same time, human resource shortages are being felt in many health professions signalling the need to better utilize the qualifications and skills of immigrant health professionals resident in Canada. Within the next 10 years, immigration will account for 100 percent of Canada's net labour force growth and given this, the need to build practical and effective solutions to the barriers facing internationally educated health professionals (IEHPs) is critical.

Through the Internationally Educated Health Professionals Initiative (IEHPI), the Government of Canada is taking action. Contribution agreements have been signed with provincial/territorial governments and organizations from across the country in order to develop collaborative and sustainable solutions. National task forces and stakeholder working groups are providing Health Canada with expert advice.

Although still a relatively new initiative, launched in 2005, promising results are already being experienced. This early success stems, in part, from excellent collaboration between various levels of government and stakeholders to promote a more coordinated and seamless approach to the integration of IEHPs.

Some accomplishments to date include the following:

- Multi-media programs for faculty and clinical educators working directly with
international medical graduates (IMGs) and internationally educated nurses
(IENs) have been developed and piloted.
- Close to 4,000 IEHPs have benefited from newly created centres, counselling and assessment services that offer specialized advice on licensure and employment.
- Bridging programs are being developed for medical radiation technologists, medical laboratory technologists, nurses, and physiotherapists to help them upgrade the needed skills for licensure.
- Work is underway to harmonize the assessment for IMGs who wish to enter a first-year residency training position. An objective of the harmonized assessment is to provide IMGs with documentation that is recognized across the country.
- Online, plain language sources of information was created and launched to help IEHPs better understand and navigate paths to licensure.
- A common orientation program for IEHPs was developed and successfully piloted through the effective collaboration of six different health professions and jurisdictional representatives.