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Health Workforce Summit: A Follow-up to the Release of an Expert Panel Report

For immediate release

Ottawa (October 20, 2014) – Leaders in health human resources from across the country will explore concrete steps needed to achieve the best use of the healthcare workforce in a meeting today at the Telfer School of Management. Organized by the pan-Canadian Health Human Resources Research Network (CHHRN), this meeting focuses on delivery of innovative models of care through changes to health professional “scopes of practice” – the tasks and responsibilities of different health workers.
 
Engaging the stakeholders to think more expansively about these issues, the meeting will feature two international keynote speakers: James Campbell, the new Director of Human Resources for Health at the World Health Organization and James Buchan, a leading expert on health workforce in the U.K., Australia and a leading consultant with the WHO and the World Bank.
 
A focus on health professional scopes of practice, both in this meeting and in a recently released report by the Canadian Academy of Health Sciences (CAHS), provides an opportunity to develop a more modern, collaborative and patient focused health care system, explained Dr. Sioban Nelson, Vice-Provost Academic Programs and former dean of the Faculty of Nursing, University of Toronto and a fellow of the Canadian Academy of Health Sciences.
 
“There’s an emerging consensus that having all members of the health care team employ their expertise and skills in collaborative practice models can provide a fundamental shift in our health care system from one that is characteristically ‘siloed’ to one that is more efficient and patient-focused.”
 
“Without doubt, it will require commitment and coordinated action by all stakeholders, but our ultimate goal is the transformation of scopes of practice and models of care to enable the future health care system to best meet the needs of Canadians,” said Dr. Jeffrey Turnbull, Chief of Staff at The Ottawa Hospital and a fellow of the Canadian Academy of Health Sciences.
 
The CAHS report is titled Optimizing Scopes of Practice: New Models of Care for a New Health Care System. It is the culmination of an 18-month-long examination of the Canadian research undertaken on this issue, as well as insights from 50 local and international key informants. This examination was carried out by a project team at the Canadian Health Human Resources Network and guided by an 11-member Expert Panel, co-chaired by Dr. Nelson and Dr. Turnbull. A summit to engage stakeholders on how to better utilize the health workforce was one of the first recommended actions in the report.

Highlights of the CAHS report

The purpose of the report was to explore ways to transform the health care system through the reconfigurations of the tasks and responsibilities of different health workers (their scopes of practice); the structure and organization of how health professionals interact and work together (their models of care); and the educational, legal, regulatory, and economic contexts in which both scopes of practice and models of care are embedded.
 
The report explains that although there have been shifts in the socio-demographic and epidemiologic profile of Canadians, dramatic technological changes, and a growing concern over healthcare “return on investment,” the way in which Canada’s health professionals work has been remarkably resistant to change.
 
The report maps out: where we are -- describing present health workforce challenges; where we want to be -- highlighting the Expert Panel’s vision statement and target outcome indicators for patients, health care professionals, and the health care system; and how we can get there -- focusing recommended actions that influence the optimization of health care professional scopes of practice and supportive models of care at various levels of influence.
 
The report highlights the barriers and enablers to optimizing scopes of practice which informed the development of the recommendations. The particular focus was on broader policies addressing funding arrangements and regulations affecting how different health professionals can work together. It was recognized that a common characteristic of particularly innovative models that optimize health professional scopes of practice is that they largely circumvent these kinds of barriers. The recommendations focused on how to shift those barriers to enablers. Namely, it argues that funders, regulators and professional groups need to come together to support the development of team-based care that allows for flexibility in the scopes of practices of regulated health workers to best meet the needs of the patients and communities they serve. The recommendations focus on ways to establish the interprofessional team as a structure within the healthcare system and develop funding and credentialing mechanisms that would allow for the safe delivery of locally flexible practices.
 
Today’s meeting at the Telfer School will be followed by a conference on Oct. 21st and 22nd at the Fairmont Château Laurier addressing broader health workforce issues, beyond scopes of practice to look at approaches to better plan for the health workforce in the future, health workforce leadership and the role of patients in the health workforce. In addition to James Campbell and James Buchan, the conference will welcome Des Gorman as an international guest to discuss some of the truly innovative health workforce policies and practices in New Zealand. Dr. Gorman is the Professor of Medicine and Associate Dean at the University of Auckland’s Faculty of Medical and Health Sciences and a Member of the Health Workforce New Zealand board.
 
The Canadian Academy of Health Sciences (CAHS) is comprised of over 400 Fellows who have attained the highest levels of academic and professional accomplishment in their respective fields. CAHS is not an advocacy group but rather an organization comprised of individuals from diverse backgrounds who have agreed to volunteer their time and expertise to participate in assessments of crucial health- and biomedical related issues affecting the lives of all Canadians.
 
The pan Canadian Health Human Resources Research Network (CHHRN) is a knowledge exchange network dedicated to providing access to the latest health workforce information and evidence on innovative approaches to health workforce development, training, financing, regulation, recruitment and retention and to connecting experts, researchers and policy/decision makers in order to better support the development and implementation of high quality, evidence-based, HHR policies and best practices.

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BACKGROUNDER

Report Overview

An expert panel assembled by the Canadian Academy of Health Sciences (CAHS) with the assistance of a Project Team at the Canadian Health Human Resources Network (CHHRN) completed an extensive assessment regarding the modernization of the health care system with a specific focus on the best use of the health workforce, more specifically investigating the tasks and responsibilities outlined within each health profession (scopes of practice).
 
The panel’s assessment is summarized in the report, Optimizing Scopes of Practice: New Models of Care For a New Health Care System, available in English and in French. The Expert Panel considered: peer reviewed articles; grey literature; evidence from interviews with key experts, innovators and policy makers; and an analysis of relevant regulatory, legal and case law documentation.
 
Over the course of 18 months the panel prepared a list of recommendations, outlined within their report, designed to guide activities associated with moving towards a modern, collaborative and patient focused health care system. The panel considered interventions at three strategic levels – practice, institution and structural.
 
Overall, they concluded that by aligning professional scopes of practice with innovative models of care, a fundamental shift within the health care system will take place allowing for a greater focus on patient care. This report provides the evidence and insights for health care providers, administrators and decision makers to think about how best to practically modernize and build a responsive Canadian health care system.
 
Report Methodology
The methodological approach of the Assessment encompassed two key components:
  • A scoping review was selected as the most appropriate form of literature review to map out the existing literature relevant to scopes of practice, thereby identifying areas of knowledge saturation and knowledge gaps where more research is required. The relevant literature was captured fromboth published and unpublished sources in Canada, as well as reviews from the United States, the United Kingdom, and Australia. A literature extraction tool was generated to systematically extract information on the key enablers and barriers to change, and to report on context, processes, and outcomes at the patient, professional, and system levels.
  • Key informant interviews (n=50) were conducted to augment the insights (and gaps) from the scoping review around a range of issues, including patient experiences, highlighting cases of complex needs where individuals must navigate across multiple levels of the health care system; innovative models that may not be formally documented; and a more in-depth consideration of process, and contextual factors, and forces impacting upon implementation, scale-up, and sustainability.
After the data were collected from the literature and key informants, the Expert Panel members, over the course of four meetings, produced a comprehensive Assessment that addresses the research question of identifying approaches to scopes of practice that will be most effective to support innovative models of care for a transformed health care system to serve all Canadians.
 

Report Recommendations:

To enable this transformation, the recommendations are directed at the multiple constituencies that define, fund, oversee, and regulate scopes of practice. Priority actions are set out under each recommendation. Funders, regulators and professional groups need to come together to support the development of team-based care that allows for flexibility in the scopes of practices of regulated health workers to best meet the needs of the patients and communities they serve. The recommendations focus on ways to establish the interprofessional team as a structure within the healthcare system and develop funding and credentialing mechanisms that would allow for the safe delivery of locally flexible practices.
 
A. The Federal Government: Provide leadership and support to encourage the expansion of collaborative care models and the evolution of scopes of practice.
• A1. Convene a national summit of all stakeholders to discuss a coordinated and prioritized plan of action based on the recommendations in this document.
• A2. Develop an infrastructure that provides arm’s- length evidence and evaluation of the health workforce with both HHR planning and deployment through optimal scopes of practice as its mandate.
• A3. Earmark research funds to address gaps in the literature, particularly those at the meso and macro levels.
• A4. Develop a national framework for guidelines and quality standards for optimal, expanded, and overlapping scopes of practice.
• A5. Promote best practices and facilitate subsequent scale-up and sustainability of initiatives across the country.
• A6. Support the development and ongoing implementation of umbrella health professional regulatory legislation across provinces and territories.
 
B. Provincial/Territorial Governments: Take the lead to create systems of funding, financing, and remuneration that enable collaborative models of care that align with patient outcomes.
• B1. Adopt alternative funding structures to support collaborative practice among professionals within
and across settings.
• B2. Initiate a review of professional and union collective agreements to examine their impact on flexibility in health professional scopes of practice.
• B3. Ensure accountability for collaborative, patient-oriented care through accreditation.
• B4. Develop mechanisms that support a move to team- or institution-based liability coverage.
• B5. Support system-wide adoption of information technologies that foster optimal scopes of practice.
 
C. Regulatory Bodies: Take the lead to align regulations in order to enable respective professionals to better meet population health needs within collaborative care models, particularly in cases of overlapping and expanded scopes of practice.
• C1. Work collaboratively with professional certification bodies to create national standards and competency frameworks that recognize training and recertification in areas of overlapping and changing scopes of practice.
• C2. Recognize certificates for advanced competencies that enable expanded scopes of practice.
 
D. Accrediting Bodies, in partnership with Quality Councils wherever possible, take the lead in establishing an accountability model through the accreditation and performance measurement of collaborative care arrangements at the community, primary care, and institution levels.
• D1. Build on existing standardized performance metrics for collaborative care models.
• D2. Build on existing metrics to inform lifelong learning and collaborative competency development for practitioners at pre- and post-licensure.
• D3. Expand accreditation to additional levels of health care service provision to include collaborative care models.
 
E. Pre-licensure and Continuing Professional Education Providers: Accelerate the ongoing development of pre-and post-licensure education practices that foster collaborative care and reflect the changing nature of required competencies.
• E1. Mandate and embed interprofessional, competency-based education across the professions so that interprofessionalism is an essential competency (rather than an additional competency).
• E2. Develop certificates for advanced collaborative practice competencies.
• E3. Develop mechanisms to support widespread engagement in lifelong learning to build and enhance collaborative care competencies.
 
F. Professional Associations and Unions: Take the lead in supporting collaborative care practice models as meeting the needs of the individual professions represented and recognizing that this is the context in which most members work or will work.
• F1. Contribute to the establishment of evidence informed guidelines for collaborative care models in which their members participate.
 

Biographies of the Co-Chairs of the CAHS Assessment

Dr. Sioban Nelson is Vice-Provost Academic Programs and former dean of the Faculty of Nursing, at the University of Toronto and a fellow of the Canadian Academy of Health Sciences. She was previously Head of the School of Nursing, Faculty of Medicine, Dentistry and Health Sciences at the University of Melbourne, Australia. Dr. Nelson has practised in a wide range of practice areas from the remote far north of Australia to inner city and home care settings. She has been engaged in nursing educational, professional and practice initiatives around the world.
 
Dr. Jeffrey Turnbull is Ottawa Hospital Chief of Staff and a fellow of the Canadian Academy of Health Sciences. He is a former president of the Canadian Medical Association and the co-founder and medical director of the Ottawa Inner City Health Project, a program that provides care to the homeless population in Ottawa, ON. As well as his work in Canada, Dr. Turnbull has been involved in health service initiatives to enhance community and institutional capacity and sustainable development in Bangladesh, Africa and the Balkans.
 

Biography of the Lead of the CHHRN Project Team

Dr. Ivy Lynn Bourgeault is a Professor in the Telfer School of Management and Institute of Population Health at the University of Ottawa. She holds a CIHR Chair in Gender, Work and Health Human Resources and leads the pan Canadian Health Human Resources Network.
 
Report and related products 

Health Canadacihr logo1This initiative has been generously funded by grants from Health Canada and the Canadian Institutes of Health Research. The views expressed here do not necessarily reflect those of the funders.