How a clinician centred approach can address challenges in healthcare

Recruitment and retention of the healthcare workforce is a global challenge; many of the solutions lie in listening to the voice of the workforce and preparing for a digital first future.

In brief

• Health systems globally are facing unprecedented challenges in recruiting and retaining their workforce
• Changing demographics, increasing patient expectations, digital transformation and shifting workforce priorities are placing increasing pressure on care delivery
  
• Ensuring the clinician voice is at the centre of improvement efforts, coupled with investments in data, digital infrastructure and digital skills can help overcome these challenges
  

The global pandemic laid bare the immeasurable value of the healthcare workforce, while simultaneously magnifying and intensifying the underlying structural and human resource challenges facing healthcare systems worldwide. Recognising the extent of this issue, the WHO declared last year that the shortage of healthcare workforces globally is no longer a looming future threat but rather it’s a crisis that must be addressed today. 

At present 1 in 5 people in Canada don’t have access to a family doctor. In Australia it’s expected that there will be a 120,000 shortfall in the nursing workforce by 2030. The Australian National Medical Workforce Strategy 2021–2031 highlighted some key concerns, which are common to health systems globally:

• Marked trend towards subspecialisation and difficulty in recruiting generalists
• Challenges in recruiting and retaining workforce in remote and rural areas
• The mental health challenges facing the healthcare workforce
• A lack of good data to support informed decision making and strategic workforce planning.

As a country with one of the fastest growing and ageing populations in Europe, and notwithstanding significant efforts to increase training places and expand the workforce, we are facing similar challenges. The ESRI’s recent analysis of our acute hospital workforce requirements, concluded that workforce expansion will be required across all regions and staff categories up to 2035. Meanwhile, a recent report on the future of Model 3 Hospitals from the NDTP and RCSI, noted that service provision in these facilities is precariously balanced, with 1 in 3 consultants over 55 years of age and a need to recruit more than one thousand Model 3 consultants over the next 10 years. Outside of acute settings, health workforce needs are also intensifying, with a 2022 ICGP report recommending a doubling of General Practice Nurses from 2000 to 4000 and the Health Service Capacity Review (2018) forecasting a 37% increase in the primary care workforce by 2031.

These workforce challenges are also happening at a time when health systems are under more pressure than ever. While the pandemic exacerbated long-standing issues and created backlogs in care which an exhausted workforce is struggling to deal with, health systems globally are also contending with additional challenges:

1. Populations are growing and living longer, placing increasing demand on existing services
2. Patient expectations are rising as they become increasingly accustomed to on-demand, anywhere-anytime, customised, and convenient services in daily life, including in the retail, banking, and entertainment industries
3. Digital transformation and the increasing decentralisation of healthcare, with a consequent need to ensure that new technologies and infrastructure seek to augment and support healthcare workers rather than add additional burden
4. Shifting perspectives of healthcare workers on careers, job profiles and the increasing importance of flexibility. EY’s Work Reimagined Survey 2023 which gaged the opinion of more than 17,000 employees globally across 25 different sectors found 71% of healthcare respondents wanted to work remotely 2 days per week. This is reflected in data from the NHS which shows a 157% increase over the past 10 years in the number of people leaving their role for work-life balance reasons.

So, what can we do to address these issues?

EY’s Global Voices in Health Care Study 2023 conducted more than 100 in-depth interviews with health service management and clinicians across 11 countries, including Ireland, and this research defined key areas where action could be taken:

Empowerment of workforce

Patient safety concerns and a lack of autonomy are primary reasons for many who consider leaving clinical roles. When we look back at the pandemic and consider what worked well, a key driver of success over that period was the removal of many of the traditional impediments to change: with many administrative and procurement barriers lifted, clinicians had the freedom to adapt and change, to self-organise, and to demonstrate on-the-ground innovation in response to clinical need and the changing local context.

This improved clinician’s day-to-day experience, made them feel more empowered, and gave them agency to effect change. The lesson for healthcare organisations is that, notwithstanding the ever-increasing pressures to deliver a greater volume of care - agency, autonomy, and culture all play a crucial role in retention of staff.

To the clinician voice

The health system is about people – with care provided for people, by people – and while many of the challenges regarding its workforce are structural or procedural, in reality only those solutions which win the hearts and minds of the care teams will be successful. To ensure this, the voice of the clinician must be included in all improvement discussions. The benefits of this are clear as illustrated by University Hospitals in Cleveland where nursing staff identified over 70 hospital policies that were redundant or no longer fit for purpose and in doing so, freed up an estimated 30% of additional time to focus on patient care.

Data-driven approach

An enormous volume of data is collected in health systems, often manually, and often at significant monetary and time expense. However, there is often an absence of feedback mechanisms to ensure that those on the frontline get access to insights from the data to inform their practice, nor are they being communicated with on how the information collected is used to drive improvements across the wider system. Investing in data and ensuring that clinical teams are provided with actionable insights from the data at the point of care will empower the health workforce, support integrated care delivery, and drive better outcomes.

Preparing now for digital transformation.

In September 2023, the WHO suggested that Europe is on the cusp of a digital health revolution and that artificial intelligence and other technologies, including automation, RPA, and hybrid care will reshape the provision of healthcare as we know it. As we move in this direction in Ireland, it is useful to reflect on the findings of the EY Global Voices in Health Care Study which noted that, while clinicians see value in some digital tools, they dislike the siloed nature of the apps and platforms that they are expected to use in their day-to-day practice.

To overcome this challenge, health systems will increasingly need to see digital health as a value-centre rather than a cost-centre and be prepared to invest in an integrated, robust digital infrastructure which is needed to underpin the safe, effective, and efficient delivery of digitally enabled models of care. In tandem with this, it will be important that the healthcare workforce of the future is served by a forward-looking curriculum that includes skill building in digital medicine and data-driven decision making, so that every frontline clinician will have at least foundational skills in digital health.

Read more at EY Global Voices in Health Care Study 2023.