Exploring the critical gaps in Canada’s health workforce planning [PODCAST]

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“We need to stop simply clapping our hands in support of health workers — and start planning to create better workforce conditions for them.  Let’s make improved health workforce science in Canada a key legacy in support of our health care workers.”

Ivy Lynn Bourgeault is a professor of sociological and anthropological studies, University of Ottawa, and the lead, Canadian Health Workforce Network.

She shares her story and discusses her KevinMD article, “The pandemic exposes critical gaps in Canada’s health workforce planning.”

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Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow. Today on the show we have Ivy Bourgeault. She’s a professor of sociological and anthropological studies at the University of Ottawa in Canada, and her KevinMD article is titled “The pandemic exposes critical gaps in Canada’s health workforce planning.” Ivy, welcome to the show.

Ivy Lynn Bourgeault: Thank you so much, Kevin.

Kevin Pho: We’ll get into the article in a little bit. First off, briefly share your story and journey to where you are today.

Ivy Lynn Bourgeault: Yeah, thank you. As you noted, I’m a professor of sociology. I lead the Canadian Health Workforce Network with a bunch of other amazing health workforce researchers here in Canada, those who really want to connect with decision-makers so that we can really implement the research that we’re doing. I held the inaugural research chair in health human resources, which is the term we use in Canada, and that was funded by the Canadian Institutes of Health Research, with money from Health Canada. And so I’ve considered myself a health workforce researcher ever since.

Kevin Pho: All right. So from your lens as a health workforce researcher, what are some of the major issues in Canada as it relates to the pandemic?

Ivy Lynn Bourgeault: Yeah, I think we see a lot of downstream impacts of the pandemic in terms of health worker burnout and health worker attrition from the workforce, so either leaving the profession altogether, or leaving a position, or reducing the amount of practice. All of those things add up to losing people in the profession and losing capacity, the service capacity of the health workforce.

Those are downstream, and my job is really to try to focus on what some upstream solutions are. That’s applying my public health training to try to say, “OK, what could we be doing better to support health workers downstream?”

Kevin Pho: So you mentioned things like burnout and health worker attrition, and those issues are certainly prevalent in the United States as well. Let’s talk more about those in your KevinMD article, titled “The pandemic exposes critical gaps in Canada’s health workforce planning.” Now, for those of you who didn’t get a chance to read your article, just walk my audience through it. Share the story of why you decided to write it.

Ivy Lynn Bourgeault: Yeah, my article came at a time when we were experiencing yet another predictable wave of the pandemic, and we seemed to be handling it in the same kind of reactive way as the first. We weren’t really a learning health system in that sense. I was frustrated to see that we didn’t seem to learn the importance of supporting the workforce.

The article presented some facts in Canada that perplexed me. So, for example, why don’t we plan for a health workforce that constitutes an estimated 8 percent of our country’s GDP? It’s a sector where one in 10 Canadians work, mostly women. Why don’t we see the connection between planning upstream for appropriate staffing and sustainable workloads, and therefore health worker wellness and support? And why couldn’t we see some upstream solutions and get started putting those in place for these potential downstream problems, which have just gotten worse since then?

Now, it’s important to note that these didn’t come about just because of the pandemic. These existed previously, and they were exacerbated by the pandemic. There had been solutions suggested earlier that could have been implemented, and so that was a bit of frustration. You could probably tell by the tone of the article.

Kevin Pho: So before getting into some of the upstream solutions, give us some examples or stories about some of the downstream things that you were seeing during that wave of the pandemic.

Ivy Lynn Bourgeault: Yeah, and it was very interesting, because we were undertaking an ongoing study looking at the pathway from the experience of mental health to the decision to take a leave of absence or not, and to return to work. This is from our ongoing Healthy Professional Workers study. We were about to launch a large survey. We had done some pilot work, and we backed off because of the pandemic. We knew that it was going to take some time, but we never anticipated how long it was going to take.

So we were collecting data at about the time that the second wave was just starting to crest in Canada. Then there were the responses to our survey, the stories that we were hearing from workers, which were really difficult to hear. There were some people that we were interviewing where I didn’t even know how they were standing, let alone responding and telling their story to us in an interview. So we were hearing that, and we also knew that there were some solutions. We wanted to pull those things together, and that was a bit of the impetus for the article.

Kevin Pho: So what were some of the things that you were hearing? Just give the audience a flavor of some of that.

Ivy Lynn Bourgeault: I remember quite distinctly the experience of one health worker who was dealing with the pandemic, dealing with all the realities of the pandemic, and was going home to a partner who thought the pandemic wasn’t real and didn’t want to have their children vaccinated. So she was dealing with death at work, because she was working in the long-term care sector, and she was dealing with denial at home. I just found that really quite remarkable. There were many stories like that.

Kevin Pho: So this was back in early 2021, and we’re speaking now in the fall of ’22. Tell us about the evolution of that. Has the situation improved?

Ivy Lynn Bourgeault: No, the situation has gotten worse. And not to be foreboding, but the situation will get worse until we give health workers hope that there is going to be some action. It’s a complex problem. It’s multi-layered, and so we’re going to need a multi-layered set of solutions.

We need to deal with the issues that we have right now: reactive solutions about retention, about returning people who have left to the workforce with support, and about recruiting in a way that’s sustainable. But we can’t just focus on recruitment to put people through a system that is essentially like a funnel that they’re coming out of. So we have to have reactive solutions, and we need proactive solutions, which is where we get into the discussion about better planning, better data for planning, and building off of some of the leading practices internationally, from countries like the U.S., like Australia, the U.K., New Zealand, etc.

Kevin Pho: All right. And like I said before, a lot of what you’re saying in terms of health worker attrition and problems recruiting mirrors the issues that we’re having in the United States as well. Now, you talk about some of the upstream solutions to tackling this problem on a reactive and proactive basis as well. So talk about some of the ways that we can get out of this.

Ivy Lynn Bourgeault: Again, a complex problem requires multiple solutions. I think, just in terms of upstream, it’s making sure that we have really good data about how health workers are actually working. We need to move away from just counting people and assuming that everybody is working the same, to measuring service capacity: how much service are they able to provide, and the types of service, right? There’s always a blend. Some people are teaching, some people are doing research, and some people are actively providing services. Some people are working full time, part time, etc., in different sectors. We need those kinds of details to have a much more on-the-ground and accurate response for planning.

We need to have those data in a very timely way, after two years of it being claimed, not even after one year. We need much more timely data to be able to make decisions on the ground. And I think that’s why there’s been some reticence by governments, because they see health workforce planning as this big, long-term initiative. And you do need to have that embedded into the system, long-term planning. But because they’re working on shorter election cycles, they want to have much better and more nimble decision-making.

So I think that we can make that type of decision-making system based on much higher-quality data, and I think that would be very much an upstream solution. But again, you have to deal with the issues that we have right now, because we haven’t done the planning. As they say, the best time to have implemented a plan was 20 years ago. The next best time is now. So let’s get started.

Kevin Pho: So give us an example of what that would look like in action. In your ideal world, give us a story or a scenario: How would the idea that you just mentioned play out?

Ivy Lynn Bourgeault: Yeah, we’ve been thinking a lot about this. We have a number of teams working on this, with some really great suggestions. I think that one thing we could do is better utilize registry data from regulatory authorities. Every practitioner has to register on a yearly basis, so let’s have a really timely data system and automatically link it. When registration happens, the data get transferred into a variety of different data visualizations so we can see what’s happening.

Now, in the United States, HRSA has created a really great dashboard that is sector-focused, and I think that is a really important leading practice to look at. Then you get the granularity down to where you need to make decisions on certain practitioners in certain states, schools, etc. So I see that as really important: really building on registry data and making sure that all the data are standardized, what we call a minimum data standard. That has been implemented in the U.S. We need to do the same in Canada.

Then we need to map that with much more nimble survey data. It doesn’t have to be of all of the workers, but getting a sense of trends. For example, Statistics Canada does a labor force survey. If we better matched the type of data on the labor force survey to the registry data, that would get some really good, detailed data on a yearly basis, and timely data in terms of people’s intention to leave an organization, to reduce their practice capacity, or to leave a place.

We were in a conversation just yesterday with a jurisdiction here in Canada that was saying, “Well, we had no idea that this family physician was no longer taking any patients in this area of great need.” Well, we need to know things like that on a very timely basis. So there are multiple layers that a data system would have, and it would be able to help decision-making.

Kevin Pho: All right. So what other ideas can be implemented to, again, help solve the workforce issue?

Ivy Lynn Bourgeault: We also need some reactive solutions to react to the problem that we have right now. So how is it that we can retain workers? Retention has been studied a lot, particularly in nursing, and so there is a good evidence base. We need to gather together what has been working, and we need to spread and scale it. We need to really ramp that up. We need to learn from other jurisdictions and other organizations in terms of what works. So those are issues around retention.

We really need, and we actually have a very poor knowledge space around, return to practice. There are a lot of challenges when someone decides to take a leave, maybe that’s for having a child or for a mental health break, and to have some bridge training to have them come back into practice. That would be the same for internationally educated health professionals that we have in our countries. Because there’s a lengthy process to recognize their skills, there’s some time lag. And also, they’ve been trained in a different system, so there’s bridging that needs to happen. Our bridge training system is very precarious, so we really need to support that, so that we’re utilizing all of the resources, all of the health human resources that we have in the community.

And then we need to recruit people and support people through the system, because we do lose folks in the system, particularly those folks who identify as Black, Indigenous, or health professionals of color. So we need to make sure that we have a supportive recruitment, retention, and return-to-work system in place.

Kevin Pho: So, looking at the data in the study, what are some of the characteristics that would lead a health care worker to burnout, and what are some of the characteristics that would lead to the retention of that health care worker?

Ivy Lynn Bourgeault: Really good questions. I think that, culturally, health workers have a propensity to really give. That’s why they went into health work in the first place, and so we need to acknowledge those predilections. The other thing that we need to understand is that the best place to intervene in terms of health worker burnout is not at an individual level, in terms of, “Let’s have workplace wellness programs.” We need to have team-based supports. We need to have organizational support, so that the onus isn’t just on the health worker to be responding to what may be a toxic environment. We have high levels of violence in health care, so we need to acknowledge that. So how do we better enable health workers to be healthy at work, and therefore to provide healthy health services?

Kevin Pho: So what are some of the obstacles that prevent the government or health care organizations from implementing some of your ideas?

Ivy Lynn Bourgeault: Yeah, some of the challenges are that we simply don’t have the data. But we can get started even with the data that we have. Some of the challenges are always political. When you talk about health policy being a very political area, the reason why it’s political is because of the health workforce. So health workforce policy is the most political area in health policy, and in policy in general.

And so I think that we have a circumstance now where many of the stakeholder organizations, from the unions to the employers to the regulatory authorities, are really quite aligned. A number of these organizations have signed on to a call to action to have much more coordinated planning for the health workforce. So what has typically been an area of some challenge and disagreement is a situation of agreement. This is what we call our political window of opportunity to really move forward.

In Canada, as in the United States, we are a federal system. So there’s always the balance of powers between the federal and provincial governments, which is the reason why we look to examples in the U.S. and in Australia for the practices that we can bring here to Canada. Everybody needs to pull up their bootstraps and be part of the solution, and to recognize that there may be some challenges. How do we work through those challenges? The health workforce is so important to us, not just from a health service perspective, but as an employment sector, for decent work, and for the economy more broadly.

Kevin Pho: We’re talking to Ivy Bourgeault. She’s a professor of sociological and anthropological studies at the University of Ottawa in Canada. Her KevinMD article, which we’re talking about today, is titled “The pandemic exposes critical gaps in Canada’s health workforce planning.” Ivy, what do you anticipate the future will bring when it comes to workforce planning?

Ivy Lynn Bourgeault: I think that we are going to have a number of people come to the table and discuss how we move forward. How do we create a stepwise implementation plan? My ideal would be for us to have a health workforce agency of some sort. That might be far in the future, but let’s come around the table and figure out the different functions that a health workforce agency would need to do in order to implement and embed better planning, and to really embed leading international evidence-informed practices into our system, so that we create a learning health workforce system. I do believe that we’ll have everybody come to the table and implement that. It may not be as fast as I’d like, but I think we will get there, because the alternative is unthinkable, really.

Kevin Pho: And my final question: What are some of the take-home messages that you want to leave with the KevinMD audience?

Ivy Lynn Bourgeault: Very good. So I’m not a health worker, but if I were a health worker, what I would do would be really pushing hard for my organization to be part of the solution, to really be saying, “We need better data to make decisions all across.” I would be willing to provide more information so that people could better plan. I think what’s frustrating is for people to provide information and then for it to go nowhere. So those would be some things that I would say to the health workers who are part of your audience. Thank you.

Kevin Pho: Ivy, thank you so much for sharing your time and insight. Thanks again for being on the show.

Ivy Lynn Bourgeault: Cheers. Thank you so much.

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