The demand for health care is on the rise due to factors such as the growing number of older (and often multimorbid) people, the growing prevalence of lifestyle factors conducive to chronic disease and the change in the definition of illness to include also those at risk of disease. But the demand for health care is not only increasing, it is also changing: due to the same factors there is a shift in the demand from acute, short-term care to chronic, long-term care.
For the health workforce these two developments imply that on the one hand there will be a rising demand for health workers and on the other hand that today’s workforce has not been trained for those activities that will be most in demand. It also means that there will likely be a mismatch between the increasing demand for care at home and in the community and a low supply of workforce in those settings.
In short, as Imison and Bohmer put it:
“Workforce redesign is needed not only because of a potentially dwindling workforce, but also because the nature of health care work is changing and the skills of the current workforce are not well matched to future needs.”
It is assumed that good workforce design is related to better quality of care. But good health workforce design is also crucial considering the fact that the health workforce is one of the main determinants of overall health care expenditure.
Data collection took place via three different channels:
1. a literature review of the international scientific literature
2. secondary data analysis of four case studies in Europe and
3. empirical research via a qualitative expert questionnaire
1. The aim of the literature review was to identity scientific literature concerning chronic conditions, integrated care and workforce changes. Relevant scientific databases were systematically searched and studies are selected based on pre-defined selection criteria and assessed independently by three researchers.
2. In phase 1 of Project Integrate, four qualitative case studies have been conducted on different chronic conditions in different European countries. This resulted in detailed case study reports. These were used as a basis for a secondary analysis with regard to workforce changes in integrated care interventions.
3. A qualitative exploratory questionnaire was sent out to experts in the fields of integrated care, chronic care, and health human resource management. By “experts” we mean persons with considerable insight into the current issues in the health human resources area, specifically regarding health human resource management and workforce changes related to integrated chronic care. Ideally, these insights were gained from their backgrounds in academia, public administration, health management and various other health professions. Experts were be identified using the snowball method starting from the members of the Project Integrate scientific committee and advisory board. Respondents were approached by email.
The research identified eight workforce changes that were commonly implemented as part of integrated chronic care interventions. These workforce changes are related to each other and are generally implemented in combination with other workforce changes. The research also identified 17 categories of barriers and facilitators to the implementation of workforce changes as part of integrated care interventions for people with chronic conditions. Positive and negative outcomes of the workforce changes were also found. Please note that detailed results of our research will be published in relevant scientific journals. For more information on (the status of) these publications, please contact the authors.
This research is relevant to inform and support policy-makers at the municipal, regional, national and European level in their decision-making regarding available types of workforce changes in integrated care interventions, the conducive context factors for the implementation of these interventions as well as the outcomes that can be expected to be achieved for people with (or at risk of) chronic conditions.