Rethinking healthcare workforce planning for uncertainty
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1. Traditional workforce planning focuses too much on numbers and makes predictions about the future that may not come to pass given uncertainties. 2. The document proposes using scenarios and modeling to better understand how different factors could impact future demand for skills and competencies rather than just headcounts. 3. It presents an example of modeling pharmacy workforce needs over time under different scenarios that show the range of possible outcomes is much wider than a single prediction, emphasizing the importance of stress testing policies against multiple futures.
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Rethinking healthcare workforce planning for uncertainty
- 1. Rethinking healthcare workforce planning Dr. Graham Willis Head of Research and Development, CfWI E: graham.willis@cfwi.org.uk T: +44(0)78 1234 0405
- 2. Main points Consider the unpredictability of the future Present uncertainty to decision makers Model skills and competences not numbers Understand what drives future demand Use scenarios to capture uncertainty Stress test before you implement
- 3. How many doctors do we need? Do we trust this? Trainedhospitaldoctors (thousands) 60 50 40 30 Year 2014 2040 Supply Demand ?
- 4. Policy What if the future is not what we expect? Failure Megatrends ProblemSystem Events
- 5. Consider many futures… Reference future Use plausible, challenging and consistent futures to test policies
- 6. Robust workforce planning Understand the system Imagine the future Stress test interventions Shape your future Focal question Transparent and participatory
- 7. Horizon scanning Contextual analysis Issues Factors Events Ideas about the future Systemic analysis
- 9. Scenario generation workshop Key factors LowImpactHigh Low Uncertainty High Predetermined Key factors Secondary
- 10. Scenario generation workshop Population GDP growth Energy usage Carbon emissions High Low CA B Consistency analysis
- 11. Scenario generation workshop Vary across different futures Formal elicitation protocol Monte Carlo simulation Probability Value Quantify critical parameters
- 13. Pharmacy example Scenarios Scenario 1 Narrower Scenario 2 Internet-driven Scenario 3 Broader Pharmacists role Enabling technology Projection 1 Projection 2 Scenario 4 e-Pharmacy
- 14. Numberofpharmacists(full-timeequivalent) 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 example How uncertain is the future?
- 15. Pharmacy example Policy options -20% -35% -50% -5% -10% -15% A B C D E F +3% One-off supply reduction Phased supply reduction then balancing increase 5 Years 10 Years
- 16. Policyoutcomes Pharmacy example Policy analysis 2 31 4 Policy options: A B C D E F
- 17. 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...
- 18. What about the rest of the system? Health Public health Social care 2% 98% Workforces not yet modelled Workforces modelled to date
- 19. What about the rest of the system? Health Public health Social 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
- 20. Skills and competences framework Competences Skills FacilitationLeadershipWellbeing Knowledge Personal Types of skill Prevent, Enable, Assess, Plan, Treat, Rehabilitate, Relieve, Link Level of skill 1 to 6 representing intensity, experience and accountability Quantitative skills Qualitative skills
- 21. A new challenge: Horizon 2035 What skills and competences do we have? What might we need in future?
- 22. Step-by-step process 1. 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?
- 23. 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
- 24. Population 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?
- 25. Population 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
- 26. Skill level 6 5 4 3 2 1 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
- 27. How demand is met today Physical LTC Mental LTC Learning disabilities Oral health Infectious diseases Maternity Singular demand
- 28. How demand is met today Percentage of hours by demand source Physical LTC Mental LTC Learning disabilities Oral health Infectious diseases Maternity Singular demand
- 29. Sources of uncertainty Quantifying critical parameters Reference future: Level 5 - 2 4 6 8 10 12 14 16 ALL Life expectancy Fertility Migration Wellness Productivity Key: median Hoursin2035(billions) 40% 40% 10% 10%
- 30. 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: 3.3Bn FTE: 2,037,000 +36%
- 31. 4. How does skills demand change? Monte Carlo simulation x
- 32. Different futures Six narrative and quantified scenarios
- 33. Different futures Components of change: business as usual Population Wellness Service Productivity 9.3Bn 12.7Bn +36% (median projections)
- 34. Change in demand by skill hours
- 35. Change in demand by skill type
- 36. Main points Consider the unpredictability of the future Present uncertainty to decision makers Model skills and competences not numbers Understand what drives future demand Use scenarios to capture uncertainty Stress test before you implement
- 37. 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
- 39. More information Horizon 2035 Future demand for skills: Initial results http://www.cfwi.org.uk/publications /horizon-2035-future-demand-for- skills-initial-results
- 40. t Rethinking workforce planning for the future Dr. Graham Willis Head of Research and Development, CfWI E: graham.willis@cfwi.org.uk T: +44(0)78 1234 0405
Hinweis der Redaktion
- Many things can push a policy off-track… Our environment, our system can change – we can have new governments. We have an election in the UK next year. Our problem might change – we might be trying to solve the wrong thing. Events can happen – we might get a medical breakthrough or a pandemic. And we have megatrends – trend we cannot easily change, like an increasing and ageing population. We have to live with them. All of these can lead to policy failure, especially if we only thing about one expected future.
- The solution is to think about many futures… We generate a set of possible futures. One of these is our expected future, but we model all of them. [If time: telescope story, actually they look backwards in time!] They are plausible, you can’t say they couldn’t happen. They are challenging, you need to make sure your plans could cope. They are consistent, they have a logical flow of cause and effect, they make sense.
- We want an approach that will allow us to create policies that are robust, that take account of the uncertainty of the future, and will lead to good outcomes. This is the framework we have developed. [explain] It is transparent and participatory. We wanted a method that open and easy to understand – unlike our previous Excel model which was a black box and impossible to understand. We also wanted to involve stakeholders in all stages. This is really important in situations that are highly political – and there is nothing more politically charged that the healthcare system. So, for example, they sense-check the model design and outputs.
- We do horizon scanning to understand the system. We know the future is complex. We have future issues – like workforce cost. We have factors that are driving change – like our ageing population We have events that might surprise us – like a technology breakthrough How do we make sense of this? We ask people for their ideas about the future. We do this online in our ideas bank. Ideas have a narrative or story about how the future might evolve, which they also quantify: Probability of the idea happening Impact if it does Workforces that might be impacted Their stakeholder group This allows us to understand people’s worries and concerns, and to map the system, the driving forces and feedback.
- We do scenario generation to explore the future. We hold stakeholder workshops. We analyse the factors from horizon scanning. We find the key factors to build scenarios. We check they are consistent. We produce narrative scenarios. We quantify them for modelling.
- Factors are analysed by their uncertainty of outcome and their impact on the focal question. And it’s going to vary. Some are more important than others. Some are less important. Some are predetermined, we have to live with them, like our ageing population. But those that are highest impact and uncertainty of outcome are the key ones we build scenarios around.
- How do we know if the key factors we select all make sense together? We use a method called cross impact analysis. Why not health and care? To avoid disagreements! Here is a simple example. We have 4 factors. Each can evolve in two ways – high or low (we could have more). Explain A B is also consistent. C has low population and GDP, but high energy usage and low emissions? A and B could be our scenarios. We usually generate 5 to 8 scenarios this way.
- To model scenarios we need to quantify the values of parameters that will vary across different futures. Examples are: Health needs of the population Working hours of the workforce Productivity of the healthcare system We ask an expert panel to produce a probability distribution to express their uncertainty. This is really important. We use a formal elicitation protocol – SHELF. We do this for the expected future, then the scenarios. We take all these future values and their uncertainty, and do a Monte Carol simulation.
- We do workforce modelling to simulate these possible futures. The model takes: Data we have and assumptions that we make Policy levers that we can control – like intake or length of training Critical parameters, their value in each future scenario – like the health needs of the population.
- An example from pharmacy. Here are four scenarios.
- Red is supply, blue is demand. The fans show the spread of uncertainty from our Monte Carlo simulation. The outer light band is 95% probability. The good news is that we are not short of pharmacists The bad news is that we are training far more pharmacists than we need. Some pharmacists training today won’t get jobs in the future. We are spending money on training that might be better spent elsewhere. In every future there is over-supply – the desirable futures and the less desirable.
- A, B, C are a one-off reduction in training intake. D, E, F are a phased reductions over 5 years, then a 3% increase over 10 years
- Policy option B – one-off 35% reduction in training intake Policy option E – phased 10% reduction in training intake over 5 years, then 3% reduction for ten years Scenario 4 is the most challenging for pharmacists – internet ordering, remote diagnosis, 3D printing of drugs Policy option B is not politically acceptable Policy option E gives flexibility and can fine-tune if things change – which they will
- Although we have made good progress in health professions – the rest of the workforce is unexplored territory!
- Another 10% for the rest of the health workforce Then huge numbers moving into social care, volunteers and unpaid carers.
- Number alone will not support effective workforce planning. We need to think about the skills and competences that people have, and their capacity to gain new skills. This requires us to think about the kinds of skills and their level of intensity.
- This is our new challenge from our Department of Health – to understand what skills and competences we have today, and how they may need to change meet the future, looking out to 2035.
- This is an example output from Horizon 2025. This is the reference future for skills demand for the whole system. Note the spread of uncertainty.!
- This is an example output from Horizon 2025. This is the reference future for skills demand for the whole system. Note the spread of uncertainty!
- This is an example output from Horizon 2025.
- We have developed a set of six scenarios for the future.
- This is an example output from Horizon 2025.
- Top three are: LTC physical LTC mental Learning disabilities
- Level 1 has highest growth (L1 = no training; L2 = some training &/or experience; L3 = 3 to 4 yrs formal edu; … L6 - +6 yrs eg consultant Levels 5 and 6 have highest uncertainty