Throughout the world, countries are experiencing shortages of health care workers. Policy-makers and system managers have developed a range of methods and initiatives to optimise the available workforce and achieve the right number and mix of personnel needed to provide high-quality care. Our literature review found that such initiatives often focus more on staff types than on staff members' skills and the effective use of those skills. Our review describes evidence about the benefits and pitfalls of current approaches to human resources optimisation in health care. We conclude that in order to use human resources most effectively, health care organisations must consider a more systemic approach - one that accounts for factors beyond narrowly defined human resources management practices and includes organisational and institutional conditions.
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Background.
Health care systems' ability to provide safe, high-quality, effective, and patient-centred services depends on sufficient, well-motivated, and appropriately skilled personnel operating within service delivery models that optimise their performance[1,2]. However, both developing and developed countries are experiencing shortages in health care human resources. Two recent major reports have estimated the global shortage at more than four million workers [3,4]. Sub-Saharan countries, for example, must nearly triple their current number of workers if they are to progress towards achieving the health Millennium Development Goals. Meanwhile, analysts project that the shortage of registered nurses in the United States (US) could reach as high as 500 000 by 2025 [5], with a projected deficit of 200 000 physicians by 2020 [6]. This looming and global human resources (HR) crisis is the culmination of shortages of physicians, nurses, allied professionals, support workers and administrators. It is also affected by factors such as societal trends towards reduced work hours, workforce ageing, and early retirement (particularly in industrialised countries).
The policies and methods used to manage HR are at the core of any sustainable solution to health care system performance and can constrain or facilitate health care sector reform [7]. In developing countries, workforce imbalances have been identified as one of the main bottlenecks that compromise population health development. In developed countries, those imbalances are manifest amidst other concerns such as waiting lists, crowded emergency departments, understaffed wards, and a lack of time to provide patient-centred care [8,9]. These difficulties arise from quantitative imbalances and from inadequate approaches to HR management that may result in overusing, underusing, or misusing available health care personnel.
Health care organisations worldwide have been exploring innovative ways to deploy their workforces. There has been a focus on staff-mix, i.e. achieving a specific mix of different types of personnel, with an increasing interest in evidence about the value and contributions of different staff-mixes to patient, personnel, and organisational outcomes. Current evidence suggests that staff-mix cannot be considered in isolation from the contexts in which people work. In order to optimise HR, managers must extend beyond simple staff-mix modifications to address organisational and system factors.
To support planner, policy makers and workforce planners, this article reviews the main approaches to and limitations of conventional health care personnel deployment. We contend that the current staff-mix focus is both restrictive and static, and that it fails to account for staff members' skills and their effective utilisation. The second part of the article examines several options that offer a more dynamic solution that introduces the notion of skill management, referring to the mechanisms used by an organisation to optimise the utilisation of its workforce. These options emphasise enabling health care providers to practise to the full extent of their education, training, skills, knowledge, experience, and competence. We conclude by discussing levers that health care organisations and systems must mobilise to ensure that available personnel are used to their fullest potential.
Throughout the world, countries are experiencing shortages of health care workers. Policy-makers and system managers have developed a range of methods and initiatives to optimise the available workforce and achieve the right number and mix of personnel needed to provide high-quality care. Our literature review found that such initiatives often focus more on staff types than on staff members' skills and the effective use of those skills. Our review describes evidence about the benefits and pitfalls of current approaches to human resources optimisation in health care. We conclude that in order to use human resources most effectively, health care organisations must consider a more systemic approach - one that accounts for factors beyond narrowly defined human resources management practices and includes organisational and institutional conditions.
Go to:
Background.
Health care systems' ability to provide safe, high-quality, effective, and patient-centred services depends on sufficient, well-motivated, and appropriately skilled personnel operating within service delivery models that optimise their performance[1,2]. However, both developing and developed countries are experiencing shortages in health care human resources. Two recent major reports have estimated the global shortage at more than four million workers [3,4]. Sub-Saharan countries, for example, must nearly triple their current number of workers if they are to progress towards achieving the health Millennium Development Goals. Meanwhile, analysts project that the shortage of registered nurses in the United States (US) could reach as high as 500 000 by 2025 [5], with a projected deficit of 200 000 physicians by 2020 [6]. This looming and global human resources (HR) crisis is the culmination of shortages of physicians, nurses, allied professionals, support workers and administrators. It is also affected by factors such as societal trends towards reduced work hours, workforce ageing, and early retirement (particularly in industrialised countries).
The policies and methods used to manage HR are at the core of any sustainable solution to health care system performance and can constrain or facilitate health care sector reform [7]. In developing countries, workforce imbalances have been identified as one of the main bottlenecks that compromise population health development. In developed countries, those imbalances are manifest amidst other concerns such as waiting lists, crowded emergency departments, understaffed wards, and a lack of time to provide patient-centred care [8,9]. These difficulties arise from quantitative imbalances and from inadequate approaches to HR management that may result in overusing, underusing, or misusing available health care personnel.
Health care organisations worldwide have been exploring innovative ways to deploy their workforces. There has been a focus on staff-mix, i.e. achieving a specific mix of different types of personnel, with an increasing interest in evidence about the value and contributions of different staff-mixes to patient, personnel, and organisational outcomes. Current evidence suggests that staff-mix cannot be considered in isolation from the contexts in which people work. In order to optimise HR, managers must extend beyond simple staff-mix modifications to address organisational and system factors.
To support planner, policy makers and workforce planners, this article reviews the main approaches to and limitations of conventional health care personnel deployment. We contend that the current staff-mix focus is both restrictive and static, and that it fails to account for staff members' skills and their effective utilisation. The second part of the article examines several options that offer a more dynamic solution that introduces the notion of skill management, referring to the mechanisms used by an organisation to optimise the utilisation of its workforce. These options emphasise enabling health care providers to practise to the full extent of their education, training, skills, knowledge, experience, and competence. We conclude by discussing levers that health care organisations and systems must mobilise to ensure that available personnel are used to their fullest potential.
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Throughout the world, countries are experiencing shortages of health care workers. Policy-makers and system managers have developed a range of methods and initiatives to optimise the available workforce and achieve the right number and mix of personnel needed to provide high-quality care. Our literature review found that such initiatives often focus more on staff types than on staff members' skills and the effective use of those skills. Our review describes evidence about the benefits and pitfalls of current approaches to human resources optimisation in health care. We conclude that in order to use human resources most effectively, health care organisations must consider a more systemic approach - one that accounts for factors beyond narrowly defined human resources management practices and includes organisational and institutional conditions.
Go to:
Background.
Health care systems' ability to provide safe, high-quality, effective, and patient-centred services depends on sufficient, well-motivated, and appropriately skilled personnel operating within service delivery models that optimise their performance[1,2]. However, both developing and developed countries are experiencing shortages in health care human resources. Two recent major reports have estimated the global shortage at more than four million workers [3,4]. Sub-Saharan countries, for example, must nearly triple their current number of workers if they are to progress towards achieving the health Millennium Development Goals. Meanwhile, analysts project that the shortage of registered nurses in the United States (US) could reach as high as 500 000 by 2025 [5], with a projected deficit of 200 000 physicians by 2020 [6]. This looming and global human resources (HR) crisis is the culmination of shortages of physicians, nurses, allied professionals, support workers and administrators. It is also affected by factors such as societal trends towards reduced work hours, workforce ageing, and early retirement (particularly in industrialised countries).
The policies and methods used to manage HR are at the core of any sustainable solution to health care system performance and can constrain or facilitate health care sector reform [7]. In developing countries, workforce imbalances have been identified as one of the main bottlenecks that compromise population health development. In developed countries, those imbalances are manifest amidst other concerns such as waiting lists, crowded emergency departments, understaffed wards, and a lack of time to provide patient-centred care [8,9]. These difficulties arise from quantitative imbalances and from inadequate approaches to HR management that may result in overusing, underusing, or misusing available health care personnel.
Health care organisations worldwide have been exploring innovative ways to deploy their workforces. There has been a focus on staff-mix, i.e. achieving a specific mix of different types of personnel, with an increasing interest in evidence about the value and contributions of different staff-mixes to patient, personnel, and organisational outcomes. Current evidence suggests that staff-mix cannot be considered in isolation from the contexts in which people work. In order to optimise HR, managers must extend beyond simple staff-mix modifications to address organisational and system factors.
To support planner, policy makers and workforce planners, this article reviews the main approaches to and limitations of conventional health care personnel deployment. We contend that the current staff-mix focus is both restrictive and static, and that it fails to account for staff members' skills and their effective utilisation. The second part of the article examines several options that offer a more dynamic solution that introduces the notion of skill management, referring to the mechanisms used by an organisation to optimise the utilisation of its workforce. These options emphasise enabling health care providers to practise to the full extent of their education, training, skills, knowledge, experience, and competence. We conclude by discussing levers that health care organisations and systems must mobilise to ensure that available personnel are used to their fullest potential.
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